Provider Demographics
NPI:1104165844
Name:NEW JERSEY COMMUNITY SPINE AND PAIN, LLC
Entity type:Organization
Organization Name:NEW JERSEY COMMUNITY SPINE AND PAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:V
Authorized Official - Last Name:GIARDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-503-4079
Mailing Address - Street 1:864 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5033
Mailing Address - Country:US
Mailing Address - Phone:732-503-4079
Mailing Address - Fax:732-503-4127
Practice Address - Street 1:864 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5033
Practice Address - Country:US
Practice Address - Phone:732-503-4079
Practice Address - Fax:732-503-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111NN0400X, 207P00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty