Provider Demographics
NPI:1104191873
Name:ESSEX VALLEY SPINE AND HEALTHCARE CENTER
Entity Type:Organization
Organization Name:ESSEX VALLEY SPINE AND HEALTHCARE CENTER
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 1:576 CENTRAL AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1951
Mailing Address - Country:US
Mailing Address - Phone:973-266-7860
Mailing Address - Fax:973-266-7861
Practice Address - Street 1:576 CENTRAL AVE
Practice Address - Street 2:STE 302
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1951
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:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty