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General NPI Number Information
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NPI Number | 1871979070
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Entity Type | Organization
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Legal Business Name | NORTH JERSEY SPINE AND REHAB
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 444 MARKET ST SUITE 3
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5996
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Country | US
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Telephone | 201-843-9441
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Fax |
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Provider Business Mailing Address
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Address Line | 444 MARKET ST SUITE 3
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5996
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Country | US
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Telephone | 201-843-8824
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL MANNO
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Credential |
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Telephone | 201-843-8824
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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 | 38MC00521900
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License Number State | NJ
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