Provider Demographics
NPI:1164810511
Name:CENTRAL JERSEY SPINE & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:CENTRAL JERSEY SPINE & REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:S
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-477-6111
Mailing Address - Street 1:47 W BROAD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOPEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525-1900
Mailing Address - Country:US
Mailing Address - Phone:609-477-6111
Mailing Address - Fax:609-466-1190
Practice Address - Street 1:47 W BROAD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HOPEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08525-1900
Practice Address - Country:US
Practice Address - Phone:609-477-6111
Practice Address - Fax:609-466-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00704400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty