Provider Demographics
NPI:1487030979
Name:SPINE WAVE, INC.
Entity Type:Organization
Organization Name:SPINE WAVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-944-9494
Mailing Address - Street 1:3 ENTERPRISE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-7620
Mailing Address - Country:US
Mailing Address - Phone:203-944-9494
Mailing Address - Fax:203-944-9493
Practice Address - Street 1:3 ENTERPRISE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-7620
Practice Address - Country:US
Practice Address - Phone:203-944-9494
Practice Address - Fax:203-944-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies