Provider Demographics
NPI:1629753058
Name:BACK AT HOME NJ
Entity Type:Organization
Organization Name:BACK AT HOME NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICHALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-802-5743
Mailing Address - Street 1:20 S ARLENE DR
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1154
Mailing Address - Country:US
Mailing Address - Phone:732-801-5743
Mailing Address - Fax:
Practice Address - Street 1:20 S ARLENE DR
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1154
Practice Address - Country:US
Practice Address - Phone:732-801-5743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty