Provider Demographics
NPI:1093980666
Name:ESSEX VALLEY SPINE CARE PC
Entity Type:Organization
Organization Name:ESSEX VALLEY SPINE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:VERLEZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-266-7860
Mailing Address - Street 1:310 CENTRAL AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2835
Mailing Address - Country:US
Mailing Address - Phone:973-266-7860
Mailing Address - Fax:973-266-7861
Practice Address - Street 1:310 CENTRAL AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2835
Practice Address - Country:US
Practice Address - Phone:973-266-7860
Practice Address - Fax:973-266-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04817111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0021849Medicaid
NJU65625Medicare UPIN
NJ819912Medicare PIN