Provider Demographics
NPI:1942308671
Name:SCORDILIS, GEORGE C (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:SCORDILIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:C
Other - Last Name:SCORDILIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1135 BROAD ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3346
Mailing Address - Country:US
Mailing Address - Phone:973-473-4481
Mailing Address - Fax:973-473-8852
Practice Address - Street 1:1135 BROAD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3346
Practice Address - Country:US
Practice Address - Phone:973-473-4481
Practice Address - Fax:973-473-8852
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00175000111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44975Medicare UPIN
NJ441342U0PMedicare ID - Type Unspecified