Provider Demographics
NPI:1871979070
Name:NORTH JERSEY SPINE AND REHAB
Entity type:Organization
Organization Name:NORTH JERSEY SPINE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-843-8824
Mailing Address - Street 1:444 MARKET ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5996
Mailing Address - Country:US
Mailing Address - Phone:201-843-8824
Mailing Address - Fax:
Practice Address - Street 1:444 MARKET ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5996
Practice Address - Country:US
Practice Address - Phone:201-843-9441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00521900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty