Provider Demographics
NPI:1073395380
Name:NY&NJ ORTHO SPINE
Entity Type:Organization
Organization Name:NY&NJ ORTHO SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:929-448-8459
Mailing Address - Street 1:369 LEXINGTON AVE FL 19
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6522
Mailing Address - Country:US
Mailing Address - Phone:929-448-8459
Mailing Address - Fax:
Practice Address - Street 1:369 LEXINGTON AVE FL 19
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6522
Practice Address - Country:US
Practice Address - Phone:929-448-8459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty