1104104967 NPI number — JOFFE CHIROPRACTIC PC

Table of content: (NPI 1104104967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104104967 NPI number — JOFFE CHIROPRACTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOFFE CHIROPRACTIC PC
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:
6
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:
1104104967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 LACEY RD STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITING
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08759-2912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-350-1188
Provider Business Mailing Address Fax Number:
732-341-2450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 LACEY RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
WHITING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08759-2938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-350-1188
Provider Business Practice Location Address Fax Number:
732-341-2450
Provider Enumeration Date:
07/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JOFFE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
WADE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-350-1188

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0002332 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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