Provider Demographics
NPI:1326379850
Name:BROADWAY CHIROPRACTIC & REHABILITATION CENTER
Entity Type:Organization
Organization Name:BROADWAY CHIROPRACTIC & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZUROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-648-1005
Mailing Address - Street 1:473 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3697
Mailing Address - Country:US
Mailing Address - Phone:201-471-2273
Mailing Address - Fax:201-471-2274
Practice Address - Street 1:473 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3697
Practice Address - Country:US
Practice Address - Phone:201-471-2273
Practice Address - Fax:201-471-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00677300111N00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty