Provider Demographics
NPI:1275792277
Name:BRUNSWICK SPINE & REHABILITATION PC
Entity Type:Organization
Organization Name:BRUNSWICK SPINE & REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOSAL
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:732-821-9979
Mailing Address - Street 1:2300 STATE ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1138
Mailing Address - Country:US
Mailing Address - Phone:732-821-9979
Mailing Address - Fax:
Practice Address - Street 1:2300 STATE ROUTE 27
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1138
Practice Address - Country:US
Practice Address - Phone:732-821-9979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00617600111N00000X
NJ40QA01136900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty