Provider Demographics
NPI:1265632533
Name:SOUTH JERSEY BRAIN AND SPINE SURGERY, LLC
Entity Type:Organization
Organization Name:SOUTH JERSEY BRAIN AND SPINE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:M A
Authorized Official - Last Name:KARIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-404-9300
Mailing Address - Street 1:76 W JIMMIE LEEDS RD
Mailing Address - Street 2:STE 501
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9411
Mailing Address - Country:US
Mailing Address - Phone:609-404-9300
Mailing Address - Fax:609-404-9305
Practice Address - Street 1:76 W JIMMIE LEEDS RD
Practice Address - Street 2:STE 501
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9411
Practice Address - Country:US
Practice Address - Phone:609-404-9300
Practice Address - Fax:609-404-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ113781Medicare PIN