Provider Demographics
NPI:1215404132
Name:HAVEN ORTHOPEDICS & SPINE INSTITUTE INC
Entity Type:Organization
Organization Name:HAVEN ORTHOPEDICS & SPINE INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FADY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-372-0000
Mailing Address - Street 1:10390 COMMERCE CENTER DR STE C100
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5858
Mailing Address - Country:US
Mailing Address - Phone:909-372-0000
Mailing Address - Fax:
Practice Address - Street 1:10390 COMMERCE CENTER DR STE C100
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5858
Practice Address - Country:US
Practice Address - Phone:909-372-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty