Provider Demographics
NPI:1417266040
Name:NEW ENGLAND SPINE AND DISC LLC
Entity Type:Organization
Organization Name:NEW ENGLAND SPINE AND DISC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-799-3472
Mailing Address - Street 1:391 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3578
Mailing Address - Country:US
Mailing Address - Phone:203-799-3472
Mailing Address - Fax:203-799-3476
Practice Address - Street 1:391 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3578
Practice Address - Country:US
Practice Address - Phone:203-799-3472
Practice Address - Fax:203-799-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4068763Medicaid
CT941550OtherPHS
CT350000365Medicare UPIN