Provider Demographics
NPI:1598853558
Name:BAMBARA, PAUL JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:BAMBARA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347D MATAWAN ROAD
Mailing Address - Street 2:TOWN SQUARE SHOPPING CENTER
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3902
Mailing Address - Country:US
Mailing Address - Phone:732-566-9696
Mailing Address - Fax:732-566-1505
Practice Address - Street 1:347D MATAWAN ROAD
Practice Address - Street 2:TOWN SQUARE SHOPPING CENTER
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3902
Practice Address - Country:US
Practice Address - Phone:732-566-9696
Practice Address - Fax:732-566-1505
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04119111N00000X
NYX006468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
223143775OtherFEDERAL TAX ID NUMBER
U33857Medicare UPIN
NJ673563Medicare ID - Type Unspecified