Provider Demographics
NPI:1548766165
Name:ORTHOPAEDIC AND SPINE INSTITUTE OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC AND SPINE INSTITUTE OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
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:201-986-6770
Mailing Address - Street 1:30 W CENTURY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1435
Mailing Address - Country:US
Mailing Address - Phone:201-986-6770
Mailing Address - Fax:201-986-1010
Practice Address - Street 1:30 W CENTURY RD STE 300
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1435
Practice Address - Country:US
Practice Address - Phone:201-986-6770
Practice Address - Fax:201-986-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22697261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical