Provider Demographics
NPI:1558691394
Name:ATLAS SPINE LLC
Entity Type:Organization
Organization Name:ATLAS SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ORIN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ATLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-261-5800
Mailing Address - Street 1:201 CREEK CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2766
Mailing Address - Country:US
Mailing Address - Phone:609-261-5800
Mailing Address - Fax:609-261-5801
Practice Address - Street 1:201 CREEK CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2766
Practice Address - Country:US
Practice Address - Phone:609-261-5800
Practice Address - Fax:609-261-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07390600207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6425970001Medicare NSC