Provider Demographics
NPI:1225766603
Name:INJURY CARE CENTER OF KEARNY
Entity Type:Organization
Organization Name:INJURY CARE CENTER OF KEARNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-349-3350
Mailing Address - Street 1:715 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3005
Mailing Address - Country:US
Mailing Address - Phone:973-349-3350
Mailing Address - Fax:973-349-3351
Practice Address - Street 1:715 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3005
Practice Address - Country:US
Practice Address - Phone:973-349-3350
Practice Address - Fax:973-349-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMC05963OtherSTATE LICENSE