Provider Demographics
NPI:1871804948
Name:HACKENSACK INJURY & WELLNESS CENTER
Entity type:Organization
Organization Name:HACKENSACK INJURY & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:CARRION
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-489-3400
Mailing Address - Street 1:335A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5826
Mailing Address - Country:US
Mailing Address - Phone:201-489-3400
Mailing Address - Fax:201-489-3411
Practice Address - Street 1:335A MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5804
Practice Address - Country:US
Practice Address - Phone:201-489-3400
Practice Address - Fax:201-489-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111NS0005X, 2081P2900X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty