Organization
THE SPINE INSTITUTE & SPORT MEDICINE OF NEW JERSEY INCORPORATE
Active
Organization
THE SPINE INSTITUTE & SPORT MEDICINE OF NEW JERSEY INCORPORATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUAN VIDAL (PRESIDENT)
(732) 641-3620
Entity
Organization
Contact information
Practice address
418 SMITH ST, PERTH AMBOY, NJ 08861-3829
(732) 641-3620
(732) 826-3613
Mailing address
418 SMITH ST, PERTH AMBOY, NJ 08861-3829
(732) 641-3620
(732) 826-3613
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
—
—
Other
Enumeration date
11/10/2011
Last updated
07/24/2013
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