Provider Demographics
NPI:1750620555
Name:NEW JERSEY SPINAL TREATMENT CENTERS
Entity type:Organization
Organization Name:NEW JERSEY SPINAL TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FOTIOU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-246-0040
Mailing Address - Street 1:184 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2938
Mailing Address - Country:US
Mailing Address - Phone:732-246-0040
Mailing Address - Fax:732-246-4923
Practice Address - Street 1:184 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2938
Practice Address - Country:US
Practice Address - Phone:732-246-0040
Practice Address - Fax:732-246-4923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00452600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty