MEDICARE: OGT CHIROPRACTIC GROUP, PA

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	111N00000X	Chiropractor	38MC00663200	NJ

General Provider Information

NPI Number	:	1588193429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OGT CHIROPRACTIC GROUP, PA

Provider Business Mailing Address
First Line	:	16 FERN RIVER RD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-4803
Country	:	US
Telephone Number	:	718-279-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 FERN RIVER RD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-4803
Country	:	US
Telephone Number	:	718-279-2900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SETH GARTENLAUB
Credential	:	DC
Telephone Number	:	718-279-2900

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	07/21/2022

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