Organization
PERFORMANCE SPINE AND SPORTS MEDICINE EAST BRUNSWICK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY SALERA (FINANCE REPRESENTATIVE)
(609) 817-0052
Entity
Organization
Contact information
Practice address
555 STATE ROUTE 18, EAST BRUNSWICK, NJ 08816-3713
(609) 817-0052
Mailing address
555 STATE ROUTE 18, EAST BRUNSWICK, NJ 08816-3713
(609) 817-0052
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
25MA08922900
NJ
174400000X
Specialist
Primary
25MA09258600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000
MULTI-SPECIALTY
NJ
Enumeration date
07/26/2016
Last updated
09/21/2016
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