Provider Demographics
NPI:1972344372
Name:NJ CUSTOM BRACING
Entity type:Organization
Organization Name:NJ CUSTOM BRACING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED INDIVIDUAL
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ATZMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-874-9777
Mailing Address - Street 1:30 N GOULD ST STE R
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1127
Practice Address - Country:US
Practice Address - Phone:973-874-9777
Practice Address - Fax:973-341-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies