Provider Demographics
NPI:1235400672
Name:PERTH AMBOY CHIROPRACTIC HEALTH CENTER, P.A.
Entity Type:Organization
Organization Name:PERTH AMBOY CHIROPRACTIC HEALTH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-442-5552
Mailing Address - Street 1:613 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-2645
Mailing Address - Country:US
Mailing Address - Phone:732-442-5552
Mailing Address - Fax:732-324-0069
Practice Address - Street 1:613 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-2645
Practice Address - Country:US
Practice Address - Phone:732-442-5552
Practice Address - Fax:732-324-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00335600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3331300Medicaid
NJT73032Medicare UPIN
NJ520330Medicare PIN