Provider Demographics
NPI:1073821989
Name:NEW JERSEY NECK & BACK INSTITUTE PC
Entity Type:Organization
Organization Name:NEW JERSEY NECK & BACK INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROCCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-896-0020
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BUILDING 6, SUITE 106
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-896-0020
Mailing Address - Fax:609-896-0041
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BUILDING 6, SUITE 106
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-896-0020
Practice Address - Fax:609-896-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty