Provider Demographics
NPI:1164997243
Name:NEW EDGE SPINE AND SPORT PLLC
Entity Type:Organization
Organization Name:NEW EDGE SPINE AND SPORT PLLC
Other - Org Name:NEW EDGE SPINE & SPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-386-8285
Mailing Address - Street 1:321 REGIS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-1453
Mailing Address - Country:US
Mailing Address - Phone:412-386-8285
Mailing Address - Fax:
Practice Address - Street 1:321 REGIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-1453
Practice Address - Country:US
Practice Address - Phone:412-737-6960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031051520001Medicaid