Provider Demographics
NPI:1033567151
Name:RIVERVIEW PAIN AND SPINE INSTITUTE PC
Entity Type:Organization
Organization Name:RIVERVIEW PAIN AND SPINE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-703-5097
Mailing Address - Street 1:725 RIVER RD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:SUITE 201A
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
Practice Address - Country:US
Practice Address - Phone:609-703-5097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07339500332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site