Provider Demographics
NPI:1447800271
Name:NORTHERN NEW JERSEY SPINE AND REHABILITATION LLC
Entity Type:Organization
Organization Name:NORTHERN NEW JERSEY SPINE AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-621-6854
Mailing Address - Street 1:111 TOWN SQUARE PL STE 420
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1724
Mailing Address - Country:US
Mailing Address - Phone:888-589-8550
Mailing Address - Fax:201-604-6571
Practice Address - Street 1:571 CENTRAL AVE STE 112
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1547
Practice Address - Country:US
Practice Address - Phone:888-589-8550
Practice Address - Fax:201-604-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNONEOtherNONE