Provider Demographics
NPI:1053659276
Name:GRANO PAIN RELIEF & WELLNESS CENTER OF PASSAIC COUNTY
Entity Type:Organization
Organization Name:GRANO PAIN RELIEF & WELLNESS CENTER OF PASSAIC COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-728-0404
Mailing Address - Street 1:1616C UNION VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1363
Mailing Address - Country:US
Mailing Address - Phone:973-728-0404
Mailing Address - Fax:973-827-0063
Practice Address - Street 1:1616C UNION VALLEY RD
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1363
Practice Address - Country:US
Practice Address - Phone:973-728-0404
Practice Address - Fax:973-827-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00596200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ136676Medicare PIN