Provider Demographics
NPI:1770817082
Name:FORT LEE HEALTH CENTER
Entity Type:Organization
Organization Name:FORT LEE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MONAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-886-8184
Mailing Address - Street 1:1067 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6329
Mailing Address - Country:US
Mailing Address - Phone:201-886-8184
Mailing Address - Fax:201-886-8483
Practice Address - Street 1:1067 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6329
Practice Address - Country:US
Practice Address - Phone:201-886-8184
Practice Address - Fax:201-886-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ566239OtherMEDICARE ID
NJU02558Medicare UPIN