Provider Demographics
NPI:1972231348
Name:INJURY CARE CENTER OF NORTH JERSEY
Entity Type:Organization
Organization Name:INJURY CARE CENTER OF NORTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-343-5190
Mailing Address - Street 1:871 ALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1943
Mailing Address - Country:US
Mailing Address - Phone:973-343-5190
Mailing Address - Fax:
Practice Address - Street 1:871 ALLWOOD RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1943
Practice Address - Country:US
Practice Address - Phone:973-343-5190
Practice Address - Fax:973-343-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty