Provider Demographics
NPI:1821410374
Name:CLIFTON PAIN & REHAB CNETER
Entity Type:Organization
Organization Name:CLIFTON PAIN & REHAB CNETER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SARACENO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-546-4200
Mailing Address - Street 1:1131 MAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011
Mailing Address - Country:US
Mailing Address - Phone:973-344-0012
Mailing Address - Fax:973-344-0898
Practice Address - Street 1:1131 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2353
Practice Address - Country:US
Practice Address - Phone:973-546-4200
Practice Address - Fax:973-546-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00591400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1205145182OtherHORIZON
NJ1982987293OtherHORIZON
NJ1437376613OtherHORIZON