Provider Demographics
NPI:1700050440
Name:NEW JERSEY BACK INSTITUTE
Entity Type:Organization
Organization Name:NEW JERSEY BACK INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-794-2169
Mailing Address - Street 1:15-01 BROADWAY
Mailing Address - Street 2:SUITE 20
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6003
Mailing Address - Country:US
Mailing Address - Phone:201-794-2169
Mailing Address - Fax:201-794-6190
Practice Address - Street 1:15-01 BROADWAY
Practice Address - Street 2:SUITE 20
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6003
Practice Address - Country:US
Practice Address - Phone:201-794-2169
Practice Address - Fax:201-794-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service