Basic Information
| Provider Information | |||||||||
| NPI: | 1346320629 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAINT CHIROPRACTIC CENTER PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MONTVALE HEALTH SPORT & SPINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 W GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | MONTVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076451813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013918282 | ||||||||
| FaxNumber: | 2013918299 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 W GRAND AVE STE 500 | ||||||||
| Address2: | |||||||||
| City: | MONTVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076451813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013918282 | ||||||||
| FaxNumber: | 2013918299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 10/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | ELS | ||||||||
| AuthorizedOfficialFirstName: | MARITZA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INSURANCE LIAISON | ||||||||
| AuthorizedOfficialTelephone: | 2013264791 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 225100000X | 40QA00892000 | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 111N00000X | 38MC00472600 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.