NPIMap

Organization Active NPI

Central Jersey Spine & Wellness L L C

  • Chiropractor
  • Freehold, NJ
National Provider Identifier
1215123641
Registry record updated Jul 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
CENTRAL JERSEY SPINE & WELLNESS L L C
Practice address
4251 Route 9 N
Building 3 Suite B
Freehold, NJ 07728-8303
Phone
(732) 683-1800
Fax
(732) 683-1090
NPI assigned
Sep 19, 2007
Last updated
Jul 31, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gerard Debernardis, DCNPI 1861417214
Title
Chiropractor
Phone
(732) 683-1800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

4251 Route 9 N
Building 3 Suite B
Freehold, NJ 07728-8303

Mailing address

4251 Route 9 N
Building 3 Suite B
Freehold, NJ 07728-8303
Phone (732) 683-1800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040109000178 NJ Part B Supplier - Clinic/Group Practice 8022918804 Receives reassigned benefits from 4 practitioners
Practice locations: Freehold, NJ
O20130731000037 NJ DME Supplier - Physician - General Surgery 8022918804 Practice locations: Freehold, NJ

National Provider Directory

National Provider Directory

Locations

4251 US Highway 9
Ste B
Freehold, NJ 07728
Phone (732) 683-1800

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375228800000",
    "number": "1215123641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4251 ROUTE 9 N",
            "address_2": "BUILDING 3 SUITE B",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077288303",
            "telephone_number": "732-683-1800",
            "fax_number": "732-683-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4251 ROUTE 9 N",
            "address_2": "BUILDING 3 SUITE B",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077288303",
            "telephone_number": "732-683-1800",
            "fax_number": "732-683-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL JERSEY SPINE & WELLNESS L L C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-19",
        "last_updated": "2013-07-31",
        "status": "A",
        "authorized_official_last_name": "DEBERNARDIS",
        "authorized_official_first_name": "GERARD",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "732-683-1800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freehold, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.