Provider Demographics
NPI:1407079833
Name:HARBORSIDE SPORT & SPINE LLC
Entity Type:Organization
Organization Name:HARBORSIDE SPORT & SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-433-1955
Mailing Address - Street 1:75 MONTGOMERY ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3726
Mailing Address - Country:US
Mailing Address - Phone:201-433-1955
Mailing Address - Fax:
Practice Address - Street 1:75 MONTGOMERY ST
Practice Address - Street 2:SUITE 603
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3726
Practice Address - Country:US
Practice Address - Phone:201-433-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00641600225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty