Provider Demographics
NPI:1710632781
Name:SOUL FOCUS MEDICAL & SPORTS REHAB
Entity Type:Organization
Organization Name:SOUL FOCUS MEDICAL & SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-935-1000
Mailing Address - Street 1:7 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2242
Mailing Address - Country:US
Mailing Address - Phone:732-935-1000
Mailing Address - Fax:732-932-9100
Practice Address - Street 1:7 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2242
Practice Address - Country:US
Practice Address - Phone:732-935-1000
Practice Address - Fax:732-932-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00542300OtherSTATE LICENSE