MEDICARE: RUN LIKE HELL-TH

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
1	261QH0100X	Health Service Clinic/Center	38MC00502900	NJ

General Provider Information

NPI Number	:	1427488766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUN LIKE HELL-TH

Provider Business Mailing Address
First Line	:	333 GRAND ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4319
Country	:	US
Telephone Number	:	201-858-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 GRAND ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4319
Country	:	US
Telephone Number	:	201-858-0444
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MICHAEL ACANFORA
Credential	:	D.C.
Telephone Number	:	201-858-0444

Provider Enumeration Date	:	11/23/2013
Last Update Date	:	04/07/2014

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Directions to “RUN LIKE HELL-TH ” Practice Location

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