1508808866 NPI number — FAMILY CHIROPRACTIC CLINIC OF HILLSBOROUGH

Table of content: (NPI 1508808866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508808866 NPI number — FAMILY CHIROPRACTIC CLINIC OF HILLSBOROUGH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CHIROPRACTIC CLINIC OF HILLSBOROUGH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508808866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 OMNI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBOROUGH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08844-4526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-359-0123
Provider Business Mailing Address Fax Number:
908-359-0143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 OMNI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBOROUGH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08844-4526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-359-0123
Provider Business Practice Location Address Fax Number:
908-359-0143
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERJU
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
908-359-0123

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00285100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 111NS0005X , with the licence number: 38MC00275300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1679546535 . This is a "NPI # DR CHRIS BERJU" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1092974 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1275506032 . This is a "NPI# DR RON BERJU" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1956906 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3212106 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1428306 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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