Provider Demographics
NPI:1619167731
Name:CENTRAL JERSEY PHYSICAL MEDICINE, LLC
Entity Type:Organization
Organization Name:CENTRAL JERSEY PHYSICAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-661-9575
Mailing Address - Street 1:565 NEW BRUNSWICK AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-2162
Mailing Address - Country:US
Mailing Address - Phone:732-661-9575
Mailing Address - Fax:732-661-9585
Practice Address - Street 1:565 NEW BRUNSWICK AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2162
Practice Address - Country:US
Practice Address - Phone:732-661-9575
Practice Address - Fax:732-661-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00473200111NI0013X
NJ40QA01051100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093363Medicare PIN