1386964286 NPI number — ATLANTIC SPINE AND JOINT INSTITUTE

Table of content: (NPI 1386964286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386964286 NPI number — ATLANTIC SPINE AND JOINT INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC SPINE AND JOINT INSTITUTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386964286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
654 W. CUTHBERT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HADDON TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-854-3472
Provider Business Mailing Address Fax Number:
856-854-9192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
654 W CUTHBERT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HADDON TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08108-3642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-854-3472
Provider Business Practice Location Address Fax Number:
856-854-9192
Provider Enumeration Date:
06/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCGRATH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
CLAUDE
Authorized Official Title or Position:
DIRECTOR OF MEDICAL SERVICES
Authorized Official Telephone Number:
856-854-3472

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  25MB08697100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)