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General NPI Number Information
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NPI Number | 1700640448
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Entity Type | Organization
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Legal Business Name | CENTURY MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 30 W CENTURY RD STE 300
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City | PARAMUS
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State | NJ
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Zip | 07652-1435
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Country | US
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Telephone | 973-574-2070
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Fax | 973-574-2088
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Provider Business Mailing Address
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Address Line | 30 W CENTURY RD STE 300
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City | PARAMUS
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State | NJ
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Zip | 07652-1435
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Country | US
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Telephone | 973-574-2070
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Fax | 973-574-2088
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Authorized Official
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Title or Position | MEMBER
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Name | DR. BRUCE JACOBSON
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Credential | DC
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Telephone | 973-574-2070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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