1942379706 NPI number — SPINE AND PAIN CENTERS, PA

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 1942379706 NPI number — SPINE AND PAIN CENTERS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINE AND PAIN CENTERS, PA
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:
1942379706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
655 SHREWSBURY AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07702-4179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-345-1180
Provider Business Mailing Address Fax Number:
732-345-8029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 HOOPER AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753-2895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-473-9530
Provider Business Practice Location Address Fax Number:
732-473-9574
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIRD
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
732-345-1180

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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