Provider Demographics
NPI:1275878571
Name:NEUROSPINE ASSOCIATES PC
Entity Type:Organization
Organization Name:NEUROSPINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVANAND
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOMINIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-545-7100
Mailing Address - Street 1:845 SIR THOMAS CT
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4843
Mailing Address - Country:US
Mailing Address - Phone:717-545-7100
Mailing Address - Fax:717-545-8100
Practice Address - Street 1:845 SIR THOMAS CT
Practice Address - Street 2:SUITE # 1
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4843
Practice Address - Country:US
Practice Address - Phone:717-545-7100
Practice Address - Fax:717-545-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty