PST Wellness Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00677900 Issued in NJ

Legal business name

PST WELLNESS CENTER

Practice address

871 Allwood Road
Clifton, NJ 07012

Phone

(973) 865-9565

Fax

(973) 365-8004

NPI assigned

Nov 19, 2009

Last updated

Dec 2, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Peter Stefan Tatarenko, D.C.

Title

Owner/Chiropractor

Phone

(973) 865-9565

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1258588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259712000000",
    "number": "1538497151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "871 ALLWOOD ROAD",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "07012",
            "telephone_number": "973-865-9565",
            "fax_number": "973-365-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "871 ALLWOOD ROAD",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "07012",
            "telephone_number": "973-865-9565",
            "fax_number": "973-365-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PST WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-19",
        "last_updated": "2009-12-02",
        "status": "A",
        "authorized_official_last_name": "TATARENKO",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "STEFAN",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "973-865-9565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00677900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.