Provider Demographics
NPI:1124424031
Name:THER CENTER FOR JOINT & SPINE RELIEF
Entity type:Organization
Organization Name:THER CENTER FOR JOINT & SPINE RELIEF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENKIN
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:201-533-0055
Mailing Address - Street 1:220 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-2714
Mailing Address - Country:US
Mailing Address - Phone:215-932-3283
Mailing Address - Fax:
Practice Address - Street 1:311 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2347
Practice Address - Country:US
Practice Address - Phone:201-533-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00721400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty