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NPI Code Detail

MEDICARE: HARBORSIDE SPORT & SPINE LLC

MEDICARE: HARBORSIDE SPORT & SPINE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation PractitionerMC00641600NJ

General Provider Information

NPI Number : 1407079833
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARBORSIDE SPORT & SPINE LLC
Provider Business Mailing Address
First Line : 75 MONTGOMERY ST
Second Line : SUITE 603
City : JERSEY CITY
State : NJ
Zip : 07302-3726
Country : US
Telephone Number : 201-433-1955
Fax Number :
Provider Business Practice Location Address
First Line : 75 MONTGOMERY ST
Second Line : SUITE 603
City : JERSEY CITY
State : NJ
Zip : 07302-3726
Country : US
Telephone Number : 201-433-1955
Fax Number :
Authorized Official
Title or Position : SINGLE MEMBER
Name : DR. DAVID SYLVESTER
Credential : DC
Telephone Number : 201-433-1955
Provider Enumeration Date : 04/11/2007
Last Update Date : 01/30/2008

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Directions to “HARBORSIDE SPORT & SPINE LLC ” Practice Location

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