Organization
PERFORMANCE SPINE AND SPORTS MEDICINE EAST BRUNSWICK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RIZKALLA M.D. (ADMINISTRATOR)
(609) 817-0050
Entity
Organization
Contact information
Practice address
555 ROUTE 18 STE 101, EAST BRUNSWICK, NJ 08816-3727
(609) 817-0052
(609) 817-0051
Mailing address
PO BOX 9925, HAMILTON, NJ 08650-1925
(609) 817-0052
(609) 817-0051
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
25MA09258600
NJ
Other
Enumeration date
05/03/2017
Last updated
12/11/2018
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