Provider Demographics
NPI:1932601564
Name:SCOLIOSIS BRACE CENTER OF NEW JERSEY, INC.
Entity type:Organization
Organization Name:SCOLIOSIS BRACE CENTER OF NEW JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:631-889-4393
Mailing Address - Street 1:265 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1820
Mailing Address - Country:US
Mailing Address - Phone:201-706-0019
Mailing Address - Fax:
Practice Address - Street 1:265 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1820
Practice Address - Country:US
Practice Address - Phone:201-706-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier