Provider Demographics
NPI:1538372362
Name:LINCOLN PARK PAIN & REHABILITATION CENTER
Entity type:Organization
Organization Name:LINCOLN PARK PAIN & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:NICOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-434-2855
Mailing Address - Street 1:2520 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2054
Mailing Address - Country:US
Mailing Address - Phone:201-434-2855
Mailing Address - Fax:
Practice Address - Street 1:2520 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-2054
Practice Address - Country:US
Practice Address - Phone:201-434-2855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00470400111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty