1659405827 NPI number — SPINE BONE AND JOINT SPECIALISTS LLC

Table of content: (NPI 1659405827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659405827 NPI number — SPINE BONE AND JOINT SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINE BONE AND JOINT SPECIALISTS 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:
1659405827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
608 N BROAD ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08096-1794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-845-0707
Provider Business Mailing Address Fax Number:
856-845-0082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 N BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08096-1794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-845-0707
Provider Business Practice Location Address Fax Number:
856-845-0082
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OBRIEN
Authorized Official First Name:
EVAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
856-845-0707

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MA63525 , 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)

  • Identifier: 2003795000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com