Provider Demographics
NPI:1750836334
Name:PERFORMANCE MEDICAL GROUP
Entity Type:Organization
Organization Name:PERFORMANCE MEDICAL GROUP
Other - Org Name:PERFORMANCE REHABILITATION AND REGENATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPIAGGIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-756-2424
Mailing Address - Street 1:10 JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-4905
Mailing Address - Country:US
Mailing Address - Phone:908-756-2424
Mailing Address - Fax:908-756-2447
Practice Address - Street 1:119 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-2147
Practice Address - Country:US
Practice Address - Phone:908-756-2424
Practice Address - Fax:908-546-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450098918208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty