Provider Demographics
NPI:1801018304
Name:NEW JERSEY SPINE AND REHABILITATION PC
Entity Type:Organization
Organization Name:NEW JERSEY SPINE AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-338-0980
Mailing Address - Street 1:200 BROADACRES DR.
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-338-0980
Mailing Address - Fax:973-338-1025
Practice Address - Street 1:111 WANAQUE AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442
Practice Address - Country:US
Practice Address - Phone:973-248-8818
Practice Address - Fax:973-248-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06328100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty