Provider Demographics
NPI:1205121316
Name:CENTER FOR JOINT AND SPINE RELIEF
Entity type:Organization
Organization Name:CENTER FOR JOINT AND SPINE RELIEF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-533-0055
Mailing Address - Street 1:218 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2736
Mailing Address - Country:US
Mailing Address - Phone:201-533-0055
Mailing Address - Fax:201-533-0066
Practice Address - Street 1:218 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2736
Practice Address - Country:US
Practice Address - Phone:201-533-0055
Practice Address - Fax:201-533-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00495100111NR0400X
NJ25MZ00057300171100000X
NJ25MA08003800208100000X, 208VP0014X
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ238516Medicare PIN