Provider Demographics
NPI:1881984268
Name:NJ CHIRO-MED, LLC
Entity type:Organization
Organization Name:NJ CHIRO-MED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:GIRGIS
Authorized Official - Last Name:MISSAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-839-5380
Mailing Address - Street 1:253 ACADEMY ST
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4307
Mailing Address - Country:US
Mailing Address - Phone:201-839-5380
Mailing Address - Fax:201-839-5727
Practice Address - Street 1:253 ACADEMY ST
Practice Address - Street 2:FLOOR 1
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4307
Practice Address - Country:US
Practice Address - Phone:201-839-5380
Practice Address - Fax:201-839-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00548300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ238184YG9PMedicare UPIN