Provider Demographics
NPI:1508433731
Name:ORTHOPAEDIC AND SPINE SURGEONS OF NJ LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC AND SPINE SURGEONS OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:VIZZONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-783-1444
Mailing Address - Street 1:242 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2812
Mailing Address - Country:US
Mailing Address - Phone:973-783-1444
Mailing Address - Fax:973-509-8421
Practice Address - Street 1:242 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2812
Practice Address - Country:US
Practice Address - Phone:973-783-1444
Practice Address - Fax:973-509-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty