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General NPI Number Information
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NPI Number | 1700944147
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Entity Type | Organization
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Legal Business Name | WATERFRONT INSTITUTE FOR SPINE AND JOINT REHABILITATION
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 10/27/2013
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Provider Practice Location Address
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Address Line | 115 RIVER RD STE 901
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City | EDGEWATER
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State | NJ
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Zip | 07020-1080
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Country | US
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Telephone | 201-840-1980
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Fax | 201-840-1987
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Provider Business Mailing Address
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Address Line | 115 RIVER RD STE 901
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City | EDGEWATER
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State | NJ
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Zip | 07020-1080
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Country | US
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Telephone | 201-840-1980
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Fax | 201-840-1987
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID P PODELL
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Credential | D. C.
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Telephone | 201-840-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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