The Spine Institute & Sport Medicine of New Jersey Incorporate

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

Legal business name

THE SPINE INSTITUTE & SPORT MEDICINE OF NEW JERSEY INCORPORATE

Practice address

418 Smith St
Perth Amboy, NJ 08861-3829

Phone

(732) 641-3620

Fax

(732) 826-3613

NPI assigned

Nov 10, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Juan Vidal

Title

President

Phone

(732) 641-3620

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1320883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374624000000",
    "number": "1700163318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 SMITH ST",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088613829",
            "telephone_number": "732-641-3620",
            "fax_number": "732-826-3613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 SMITH ST",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088613829",
            "telephone_number": "732-641-3620",
            "fax_number": "732-826-3613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SPINE INSTITUTE & SPORT MEDICINE OF NEW JERSEY INCORPORATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-10",
        "last_updated": "2013-07-24",
        "status": "A",
        "authorized_official_last_name": "VIDAL",
        "authorized_official_first_name": "JUAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-641-3620",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Physician Chiropractor in Perth Amboy, NJ
• Providers in Perth Amboy, NJ by specialty
• Sports Physician Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; 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.