Provider Demographics
NPI:1659075026
Name:MOORESTOWN SPINE SPORTS AND WELLNESS
Entity Type:Organization
Organization Name:MOORESTOWN SPINE SPORTS AND WELLNESS
Other - Org Name:CONCIERGE SPINE AND SPORTS MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MALINI
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-262-5629
Mailing Address - Street 1:200 MARTER AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3147
Mailing Address - Country:US
Mailing Address - Phone:856-661-7900
Mailing Address - Fax:856-250-1464
Practice Address - Street 1:201 WHITE HORSE RD E
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2601
Practice Address - Country:US
Practice Address - Phone:856-661-7900
Practice Address - Fax:856-250-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty