Provider Demographics
NPI:1124065024
Name:MONMOUTH BACK & NECK REHABILITATION LLC
Entity type:Organization
Organization Name:MONMOUTH BACK & NECK REHABILITATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
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 ROAD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
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:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03114111N00000X
NJQA07415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty