Provider Demographics
NPI:1760766836
Name:KIRSHNER SPINE INSTITUTE, LLC
Entity Type:Organization
Organization Name:KIRSHNER SPINE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:KIRSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-267-5629
Mailing Address - Street 1:525 ROUTE 73 S STE 302
Mailing Address - Street 2:EVESHAM COMMONS
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9644
Mailing Address - Country:US
Mailing Address - Phone:856-267-5629
Mailing Address - Fax:856-574-4043
Practice Address - Street 1:525 ROUTE 73 S STE 302
Practice Address - Street 2:EVESHAM COMMONS
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9644
Practice Address - Country:US
Practice Address - Phone:856-267-5629
Practice Address - Fax:856-574-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA45874207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD66752Medicare UPIN
NJRE137317Medicare PIN