Provider Demographics
NPI:1205442118
Name:PLAZA CHIROPRACTIC AND SPORTS MEDICINE PC
Entity type:Organization
Organization Name:PLAZA CHIROPRACTIC AND SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-723-0023
Mailing Address - Street 1:1314 ENGLISHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1580
Mailing Address - Country:US
Mailing Address - Phone:732-723-0023
Mailing Address - Fax:732-723-1614
Practice Address - Street 1:1314 ENGLISHTOWN RD
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1580
Practice Address - Country:US
Practice Address - Phone:732-723-0023
Practice Address - Fax:732-723-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty