MEDICARE: LINCOLN PARK PAIN & REHABILITATION CENTER

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	111NR0400X	Rehabilitation Chiropractor	38MC00470400	NJ

General Provider Information

NPI Number	:	1538372362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN PARK PAIN & REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	2520 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-2054
Country	:	US
Telephone Number	:	201-434-2855
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-2054
Country	:	US
Telephone Number	:	201-434-2855
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES G NICOLA
Credential	:	D.O.
Telephone Number	:	201-434-2855

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/22/2020

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