Provider Demographics
NPI:1568665560
Name:SPINE SURGERY ASSOCIATES & DISCOVERY IMAGING, PC
Entity Type:Organization
Organization Name:SPINE SURGERY ASSOCIATES & DISCOVERY IMAGING, PC
Other - Org Name:SPINE SURGERY ASSOCIATES, M.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:VESSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-532-0576
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:PLUCKEMIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07978-0323
Mailing Address - Country:US
Mailing Address - Phone:908-532-0576
Mailing Address - Fax:908-532-0578
Practice Address - Street 1:280 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2775
Practice Address - Country:US
Practice Address - Phone:908-532-0576
Practice Address - Fax:908-532-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ191711Medicare PIN
NJSP191711Medicare ID - Type UnspecifiedGROUP NUMBER