1447800271 NPI number — NORTHERN NEW JERSEY SPINE AND REHABILITATION LLC

Table of content: (NPI 1447800271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447800271 NPI number — NORTHERN NEW JERSEY SPINE AND REHABILITATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN NEW JERSEY SPINE AND REHABILITATION 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:
1447800271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 TOWN SQUARE PL STE 420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07310-1724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-589-8550
Provider Business Mailing Address Fax Number:
201-604-6571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
571 CENTRAL AVE STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PROVIDENCE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07974-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-589-8550
Provider Business Practice Location Address Fax Number:
201-604-6571
Provider Enumeration Date:
09/13/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHAUDHRY
Authorized Official First Name:
HAROON
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
917-621-6854

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP3300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: NONE . This is a "NONE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".