Provider Demographics
NPI:1154589000
Name:GINA M. POLETTI LECKBURG,D.C.
Entity type:Organization
Organization Name:GINA M. POLETTI LECKBURG,D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLETTI LECKBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-874-5402
Mailing Address - Street 1:648 US HIGHWAY 206 SOUTH
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1511
Mailing Address - Country:US
Mailing Address - Phone:908-874-5402
Mailing Address - Fax:908-874-0651
Practice Address - Street 1:648 US HIGHWAY 206 SOUTH
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1511
Practice Address - Country:US
Practice Address - Phone:908-874-5402
Practice Address - Fax:908-874-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC002471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty