Provider Demographics
NPI:1003154519
Name:SPINE & SPORTS MEDICINE OF BARNEGAT, L.L.C.
Entity Type:Organization
Organization Name:SPINE & SPORTS MEDICINE OF BARNEGAT, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-660-0002
Mailing Address - Street 1:175 GUNNING RIVER RD
Mailing Address - Street 2:BUILDING D
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-1436
Mailing Address - Country:US
Mailing Address - Phone:609-660-0002
Mailing Address - Fax:609-660-0003
Practice Address - Street 1:175 GUNNING RIVER RD
Practice Address - Street 2:BUILDING D
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-1436
Practice Address - Country:US
Practice Address - Phone:732-714-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00577500111N00000X
2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1811010549OtherNPI NUMBER
NJ1760519102OtherNPI NUMBER