Provider Demographics
NPI:1578733028
Name:ATLANTIC SPINE SPECIALISTS
Entity Type:Organization
Organization Name:ATLANTIC SPINE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HACK-GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-971-3500
Mailing Address - Street 1:131 MADISON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7360
Mailing Address - Country:US
Mailing Address - Phone:973-971-3500
Mailing Address - Fax:973-683-0016
Practice Address - Street 1:131 MADISON AVE STE 110
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7360
Practice Address - Country:US
Practice Address - Phone:973-971-3500
Practice Address - Fax:973-683-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ041679Medicare PIN