Provider Demographics
NPI:1750683132
Name:PERTH AMBOY SPINE AND JOINT CARE
Entity Type:Organization
Organization Name:PERTH AMBOY SPINE AND JOINT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-874-9084
Mailing Address - Street 1:75 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4413
Mailing Address - Country:US
Mailing Address - Phone:201-874-9084
Mailing Address - Fax:973-361-2721
Practice Address - Street 1:75 SMITH ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4413
Practice Address - Country:US
Practice Address - Phone:201-874-9084
Practice Address - Fax:973-361-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty