Provider Demographics
NPI:1710282132
Name:COLTS NECK SPINE & JOINT CARE LLC
Entity Type:Organization
Organization Name:COLTS NECK SPINE & JOINT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUGO
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:732-615-9420
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-0051
Mailing Address - Country:US
Mailing Address - Phone:973-361-2722
Mailing Address - Fax:973-361-2721
Practice Address - Street 1:1270 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2014
Practice Address - Country:US
Practice Address - Phone:732-615-9420
Practice Address - Fax:732-615-9427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ123123123123123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty