Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 38MC00746700 | NJ |
N | 111NR0400X | Rehabilitation Chiropractor | 38MC00746700 | NJ |
N | 111NS0005X | Chiropractic Sports Physician | 38MC00746700 | NJ |
NPI | 1215458898 |
---|---|
Provider Name | Dr. Jared Bornstein |
First Address | Manalapan, NJ 07726-4153 |
Second Address | Eatontown, NJ 07724-2242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2017 |
Last Update Date | 28/11/2018 |