Provider Demographics
NPI:1003152299
Name:CENTRAL JERSEY MEDICAL & CONSULTING, LLC
Entity Type:Organization
Organization Name:CENTRAL JERSEY MEDICAL & CONSULTING, LLC
Other - Org Name:BANDA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-462-2986
Mailing Address - Street 1:760 RAVINE ROAD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-3171
Mailing Address - Country:US
Mailing Address - Phone:908-462-2986
Mailing Address - Fax:
Practice Address - Street 1:230 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3137
Practice Address - Country:US
Practice Address - Phone:908-821-5390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC0274700261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ196244OtherMEDICARE