MEDICARE: CENTRAL JERSEY PHYSICAL MEDICINE, 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
1	225100000X	Physical Therapist	40QA01051100	NJ
2	111NI0013X	Independent Medical Examiner Chiropractor	38MC00473200	NJ

General Provider Information

NPI Number	:	1619167731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL JERSEY PHYSICAL MEDICINE, LLC

Provider Business Mailing Address
First Line	:	565 NEW BRUNSWICK AVE
Second Line	:	SUITE 3
City	:	FORDS
State	:	NJ
Zip	:	08863-2162
Country	:	US
Telephone Number	:	732-661-9575
Fax Number	:	732-661-9585

Provider Business Practice Location Address
First Line	:	565 NEW BRUNSWICK AVE
Second Line	:	SUITE 3
City	:	FORDS
State	:	NJ
Zip	:	08863-2162
Country	:	US
Telephone Number	:	732-661-9575
Fax Number	:	732-661-9585

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	DR. STEVEN L. FARBER
Credential	:	D.C.
Telephone Number	:	732-661-9575

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	09/26/2007

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