NPIMap

Organization Active NPI

Spine & Sports Medicine of Freehold, LLC

  • Physical Medicine & Rehabilitation Physician
  • Freehold, NJ
National Provider Identifier
1952878019
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
SPINE & SPORTS MEDICINE OF FREEHOLD, LLC
Practice address
1050 W Main St
Freehold, NJ 07728-2509
Phone
(732) 475-4959
Fax
(732) 780-7139
NPI assigned
Oct 26, 2018
Last updated
May 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Authorized official

Name
Nicole FullawayNPI 1235442690
Title
Director
Phone
(732) 714-0070

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU
Acupuncturist 171100000X NU
Orthopaedic Surgery Physician 207X00000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

1050 W Main St
Freehold, NJ 07728-2509

Mailing address

1050 W Main St
Freehold, NJ 07728-2509

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190213002451 NJ Part B Supplier - Clinic/Group Practice 0749528933 Receives reassigned benefits from 21 practitioners
Practice locations: Freehold, NJ

National Provider Directory

National Provider Directory

Locations

1050 W Main St
Freehold, NJ 07728
Phone (732) 475-4959

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1540512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1952878019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W MAIN ST",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W MAIN ST",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282509",
            "telephone_number": "732-475-4959",
            "fax_number": "732-780-7139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE & SPORTS MEDICINE OF FREEHOLD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-26",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "FULLAWAY",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "732-714-0070"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "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 May 9, 2024; 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.