Provider Demographics
NPI:1851443964
Name:NEW JERSEY TOTAL HEALTH CENTER
Entity type:Organization
Organization Name:NEW JERSEY TOTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-472-5433
Mailing Address - Street 1:2 ARNOT ST
Mailing Address - Street 2:STE 3
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1629
Mailing Address - Country:US
Mailing Address - Phone:973-472-5433
Mailing Address - Fax:973-473-6833
Practice Address - Street 1:2 ARNOT ST
Practice Address - Street 2:STE 3
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1629
Practice Address - Country:US
Practice Address - Phone:973-472-5433
Practice Address - Fax:973-473-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-06-18
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
NJ=========DOtherBLUE CROSS BLUE SHIELD
NJ045562Medicare PIN