Organization
PERFORMANCE SPINE AND SPORTS MEDICINE OF BORDENTOWN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHIAS HEINZ WIEDERHOLZ M.D (OWNER)
(609) 588-8600
Entity
Organization
Contact information
Practice address
9500 K. JOHNSON BLVD, SUITE 1, BORDENTOWN, NJ 08505-4400
(609) 588-8600
(609) 588-8602
Mailing address
9500 K. JOHNSON BLVD, SUITE 1, BORDENTOWN, NJ 08505-4400
(609) 588-8600
(609) 588-8602
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
25MA08436100
NJ
Other
Enumeration date
08/22/2014
Last updated
08/22/2014
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