Provider Demographics
NPI:1679075642
Name:PERFORMANCE MEDICAL GROUP OF BRANCHBURG LLC
Entity Type:Organization
Organization Name:PERFORMANCE MEDICAL GROUP OF BRANCHBURG LLC
Other - Org Name:PERFORMANCE REHABILITATION & REGENERATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR/ OWNER
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 HIGHWAY 22 STE 203
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2979
Mailing Address - Country:US
Mailing Address - Phone:908-756-2424
Mailing Address - Fax:908-450-2500
Practice Address - Street 1:3150 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3595
Practice Address - Country:US
Practice Address - Phone:908-756-2424
Practice Address - Fax:908-546-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty