Provider Demographics
NPI:1558546127
Name:PUGLIESE SPINE AND SPORTS INJURY ASSCOCIATES, LLC
Entity Type:Organization
Organization Name:PUGLIESE SPINE AND SPORTS INJURY ASSCOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGLIESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-654-3040
Mailing Address - Street 1:812 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-5625
Mailing Address - Country:US
Mailing Address - Phone:908-654-3040
Mailing Address - Fax:908-654-9286
Practice Address - Street 1:812 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-5625
Practice Address - Country:US
Practice Address - Phone:908-654-3040
Practice Address - Fax:908-654-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05950111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ120937Medicare PIN
NJ065156Medicare UPIN