Provider Demographics
NPI:1922219963
Name:MONMOUTH BACK & NECK REHABILITATION, LLC
Entity Type:Organization
Organization Name:MONMOUTH BACK & NECK REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DINONNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-780-8832
Mailing Address - Street 1:300 CRAIG ROAD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:732-780-8832
Mailing Address - Fax:732-845-1344
Practice Address - Street 1:300 CRAIG RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8742
Practice Address - Country:US
Practice Address - Phone:732-780-8832
Practice Address - Fax:732-845-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ041546Medicare ID - Type Unspecified