Provider Demographics
NPI:1215123641
Name:CENTRAL JERSEY SPINE & WELLNESS L L C
Entity type:Organization
Organization Name:CENTRAL JERSEY SPINE & WELLNESS L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBERNARDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-683-1800
Mailing Address - Street 1:4251 ROUTE 9 N
Mailing Address - Street 2:BUILDING 3 SUITE B
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8303
Mailing Address - Country:US
Mailing Address - Phone:732-683-1800
Mailing Address - Fax:732-683-1090
Practice Address - Street 1:4251 ROUTE 9 N
Practice Address - Street 2:BUILDING 3 SUITE B
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8303
Practice Address - Country:US
Practice Address - Phone:732-683-1800
Practice Address - Fax:732-683-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ040646Medicare PIN