Provider Demographics
NPI:1649364431
Name:FACTOR, MINDY (DC, RN)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:
Last Name:FACTOR
Suffix:
Gender:F
Credentials:DC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1751
Mailing Address - Country:US
Mailing Address - Phone:732-364-3366
Mailing Address - Fax:
Practice Address - Street 1:1221 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1751
Practice Address - Country:US
Practice Address - Phone:732-364-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00427800111N00000X
NJNR79046163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered163W00000XNursing Service ProvidersRegistered Nurse