Provider Demographics
NPI:1518477918
Name:PERFORMANCE MEDICAL OF WATCHUNG LLC
Entity Type:Organization
Organization Name:PERFORMANCE MEDICAL OF WATCHUNG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIAGGIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-756-2424
Mailing Address - Street 1:1011 US 22
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:908-756-2424
Mailing Address - Fax:908-450-1880
Practice Address - Street 1:459 WATCHUNG AVE
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-4945
Practice Address - Country:US
Practice Address - Phone:908-756-2424
Practice Address - Fax:908-546-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty