Provider Demographics
NPI:1710302401
Name:BROADWAY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BROADWAY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TARTAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-222-5107
Mailing Address - Street 1:628 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1918
Mailing Address - Country:US
Mailing Address - Phone:973-222-5107
Mailing Address - Fax:
Practice Address - Street 1:628 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1918
Practice Address - Country:US
Practice Address - Phone:973-222-5107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00590400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty