Provider Demographics
NPI:1548412497
Name:NEW JERSEY SPINE INSTITUTE, P.A.
Entity Type:Organization
Organization Name:NEW JERSEY SPINE INSTITUTE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHIBALD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:908-722-0822
Mailing Address - Street 1:1 ROBERTSON DR
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-1716
Mailing Address - Country:US
Mailing Address - Phone:908-234-9200
Mailing Address - Fax:908-234-2070
Practice Address - Street 1:1 ROBERTSON DR
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1716
Practice Address - Country:US
Practice Address - Phone:908-234-9200
Practice Address - Fax:908-234-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ026967Medicare PIN