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General NPI Number Information
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NPI Number | 1932601564
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Entity Type | Organization
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Legal Business Name | SCOLIOSIS BRACE CENTER OF NEW JERSEY, INC.
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 265 US HIGHWAY 46
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City | TOTOWA
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State | NJ
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Zip | 07512-1820
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Country | US
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Telephone | 201-706-0019
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Fax |
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Provider Business Mailing Address
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Address Line | 265 US HIGHWAY 46
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City | TOTOWA
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State | NJ
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Zip | 07512-1820
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Country | US
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Telephone | 201-706-0019
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Fax |
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Authorized Official
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Title or Position | ORTHOTIST
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Name | MR. VINCENT BEAUMAN
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Credential | CO
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Telephone | 631-889-4393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | NY
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