Fontanarosa Chiropractic Inc
Organization Active NPI Chiropractor · Hawthorne, NJ
NPI 1376649764 · NPPES record last updated Apr 15, 2011
Key facts
- NPI
- 1376649764
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4435 (NJ)
- Legal business name
- FONTANAROSA CHIROPRACTIC INC
- Practice address
- 274 Lafayette Ave
Hawthorne, NJ 07506-1962 - Phone
- (973) 423-9600
- NPI assigned
- Sep 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Mila Jeremic
- Title
- Office Manager
- Phone
- (973) 423-9600
Practitioners 2
-
Domenic Fontanarosa, D.C.
-
Edward Janiga, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110411000244 | NJ | Part B Supplier - Clinic/Group Practice | 4385828722 |
Receives reassigned benefits from 1 practitioner Practice locations: Hawthorne, NJ |
National Provider Directory
Locations
274 Lafayette Ave
Hawthorne, NJ 07506
Phone (973) 423-2015
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4435 | NJ | Yes |
Addresses
Primary practice location
274 Lafayette Ave
Hawthorne, NJ 07506-1962
Mailing address
274 Lafayette Ave
Hawthorne, NJ 07506-1962
Phone (973) 423-9600
Other providers in Hawthorne, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.