Provider Demographics
NPI:1427109339
Name:BARNEGAT SPINAL AND PHYSICAL REHABILITATION , LLC
Entity type:Organization
Organization Name:BARNEGAT SPINAL AND PHYSICAL REHABILITATION , LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-698-2552
Mailing Address - Street 1:492 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2422
Mailing Address - Country:US
Mailing Address - Phone:609-698-2552
Mailing Address - Fax:609-698-8774
Practice Address - Street 1:492 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2422
Practice Address - Country:US
Practice Address - Phone:609-698-2552
Practice Address - Fax:609-698-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ111326Medicare PIN