Provider Demographics
NPI:1164294005
Name:WELL SPINE AND ORTHOPEDIC CENTER CORP
Entity Type:Organization
Organization Name:WELL SPINE AND ORTHOPEDIC CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:SINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENASHEHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-376-9576
Mailing Address - Street 1:1003 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1003 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2333
Practice Address - Country:US
Practice Address - Phone:917-376-9576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty