1134557523 NPI number — NEW JERSEY SPINE AND ORTHOPEDICS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134557523 NPI number — NEW JERSEY SPINE AND ORTHOPEDICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW JERSEY SPINE AND ORTHOPEDICS, LLC
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:
1134557523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 US HWY 22
Provider Second Line Business Mailing Address:
STE # 14
Provider Business Mailing Address City Name:
BRIDGEWATER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-376-6595
Provider Business Mailing Address Fax Number:
973-741-3900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 US HWY 22
Provider Second Line Business Practice Location Address:
STE # 14
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-376-6595
Provider Business Practice Location Address Fax Number:
973-741-3900
Provider Enumeration Date:
10/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KATZMAN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
855-586-2615

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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