Provider Demographics
NPI:1598279218
Name:SPINE INSTITUTE OF NORTH AMERICA LLC
Entity Type:Organization
Organization Name:SPINE INSTITUTE OF NORTH AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:YANNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-371-9100
Mailing Address - Street 1:300A PRINCETON HIGHTSTOWN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-1421
Mailing Address - Country:US
Mailing Address - Phone:609-371-9100
Mailing Address - Fax:
Practice Address - Street 1:385 CRANBURY RD STE 2
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3000
Practice Address - Country:US
Practice Address - Phone:609-371-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain