Provider Demographics
NPI: | 1467522235 |
---|---|
Name: | CENTER FOR EVALUATION AND TREATMENT OF NEUROMUSCULAR AND ORTHOPEDIC DI |
Entity Type: | Organization |
Organization Name: | CENTER FOR EVALUATION AND TREATMENT OF NEUROMUSCULAR AND ORTHOPEDIC DI |
Other - Org Name: | -SORDERS AND INJURIES PA |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MONICA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MEHTA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 201-656-4324 |
Mailing Address - Street 1: | 191 PALISADE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | JERSEY CITY |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07306-1112 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 201-656-3647 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 191 PALISADE AVE |
Practice Address - Street 2: | |
Practice Address - City: | JERSEY CITY |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07306-1133 |
Practice Address - Country: | US |
Practice Address - Phone: | 201-656-4324 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-09 |
Last Update Date: | 2012-10-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 33984 | 204C00000X, 204D00000X, 208100000X, 2081P0004X, 2081P0010X, 2081P2900X, 2081S0010X, 2083S0010X, 2083X0100X, 208VP0000X, 208VP0014X, 209800000X, 261Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
No | 204C00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | Group - Multi-Specialty | |
No | 204D00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2081P0004X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine | Group - Multi-Specialty |
No | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | Group - Multi-Specialty |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | Group - Multi-Specialty |
No | 2083S0010X | Allopathic & Osteopathic Physicians | Preventive Medicine | Sports Medicine | Group - Multi-Specialty |
No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
No | 209800000X | Allopathic & Osteopathic Physicians | Legal Medicine | Group - Multi-Specialty |