Provider Demographics
NPI:1114466901
Name:NORTHEASTERN SPINE & PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:NORTHEASTERN SPINE & PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-699-2342
Mailing Address - Street 1:3621 ROUTE 94
Mailing Address - Street 2:UNIT#2
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-9651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3621 ROUTE 94
Practice Address - Street 2:UNIT#2
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419-9651
Practice Address - Country:US
Practice Address - Phone:973-864-8997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty