Provider Demographics
NPI:1437359114
Name:JERSEY CITY NECK & BACK CENTER, PC
Entity Type:Organization
Organization Name:JERSEY CITY NECK & BACK CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MASCENIK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:201-420-1165
Mailing Address - Street 1:590 NEWARK AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2302
Mailing Address - Country:US
Mailing Address - Phone:201-420-1165
Mailing Address - Fax:201-420-6893
Practice Address - Street 1:590 NEWARK AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2302
Practice Address - Country:US
Practice Address - Phone:201-420-1165
Practice Address - Fax:201-420-6893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO-6174111N00000X
NJ40QA01212100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty