NPIMap

Organization Active NPI

Garden State Spine and Rehabilitation

  • Chiropractor
  • Freehold, NJ
National Provider Identifier
1780282269
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
GARDEN STATE SPINE AND REHABILITATION
Practice address
55-77 Schanck Rd Ste B-17
Freehold, NJ 07728-2964
Phone
(732) 414-6060
Fax
(732) 414-6061
NPI assigned
Oct 15, 2020
Last updated
Oct 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Authorized official

Name
Noah MillerNPI 1700136389
Title
Owner
Phone
(908) 415-5414

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X Primary

Addresses

Primary practice location

55-77 Schanck Rd Ste B-17
Freehold, NJ 07728-2964

Mailing address

55-77 Schanck Rd Ste B-17
Freehold, NJ 07728-2964
Phone (732) 414-6060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201123000412 NJ Part B Supplier - Clinic/Group Practice 0143631283 Receives reassigned benefits from 9 practitioners
Practice locations: Freehold, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1780282269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55-77 SCHANCK RD STE B-17",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282964",
            "telephone_number": "732-414-6060",
            "fax_number": "732-414-6061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55-77 SCHANCK RD STE B-17",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282964",
            "telephone_number": "732-414-6060",
            "fax_number": "732-414-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDEN STATE SPINE AND REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-15",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "NOAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-415-5414"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 Oct 15, 2020; 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.