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General NPI Number Information
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NPI Number | 1679707251
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Entity Type | Organization
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Legal Business Name | MONBACK L.L.C.
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 86 PLYMOUTH ST
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City | FAIRFIELD
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State | NJ
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Zip | 07004-1605
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Country | US
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Telephone | 973-227-7105
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Fax |
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Provider Business Mailing Address
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Address Line | 34 WHIMBLE CT
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City | WAYNE
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State | NJ
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Zip | 07470-8463
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Country | US
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Telephone | 201-232-2596
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL B. RODIS
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Credential | DC
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Telephone | 201-232-2596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 05576
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License Number State | NJ
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