Provider Demographics
NPI:1356341903
Name:SANFILIPPO, JAMES J (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:SANFILIPPO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3003
Mailing Address - Country:US
Mailing Address - Phone:201-997-7171
Mailing Address - Fax:201-997-2087
Practice Address - Street 1:699 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3003
Practice Address - Country:US
Practice Address - Phone:201-997-7171
Practice Address - Fax:201-997-2087
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP630580OtherOXFORD PROVIDER ID #
NJ8694401Medicaid
NJP630580OtherOXFORD PROVIDER ID #
NJ8694401Medicaid