Provider Demographics
NPI:1679642342
Name:MIDTOWN FAMILY CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:MIDTOWN FAMILY CHIROPRACTIC CENTER PC
Other - Org Name:MIDTOWN PHYSICAL THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-339-2226
Mailing Address - Street 1:25 BOLAND DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3675
Mailing Address - Country:US
Mailing Address - Phone:201-339-2225
Mailing Address - Fax:201-339-7392
Practice Address - Street 1:901 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3012
Practice Address - Country:US
Practice Address - Phone:201-339-2226
Practice Address - Fax:201-339-7392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2273261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1661809Medicaid
NJ3187209Medicaid
NJ3187209Medicaid
NJ035415Medicare ID - Type UnspecifiedINDIVIDUAL MCARE #