Provider Demographics
NPI:1366715963
Name:CHIROMED GROUP BAYONNE LLC
Entity type:Organization
Organization Name:CHIROMED GROUP BAYONNE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TABISH
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-216-3329
Mailing Address - Street 1:101 W 24TH ST
Mailing Address - Street 2:APT 12A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1909
Mailing Address - Country:US
Mailing Address - Phone:917-216-3329
Mailing Address - Fax:212-867-8226
Practice Address - Street 1:10 E. 22ND STREET
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3708
Practice Address - Country:US
Practice Address - Phone:201-339-8889
Practice Address - Fax:201-339-2822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROMED GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP3300X, 261QP2000X
NJ38MC00180500111N00000X
NJ25MA08272600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFE457526Medicare PIN