Provider Demographics
NPI:1801040027
Name:SPINE EXPOSURE SPECIALISTS LLC
Entity Type:Organization
Organization Name:SPINE EXPOSURE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOFMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:908-376-1529
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07902-0151
Mailing Address - Country:US
Mailing Address - Phone:908-376-1529
Mailing Address - Fax:908-634-0323
Practice Address - Street 1:47 MAPLE STREET
Practice Address - Street 2:SUITE 407
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2571
Practice Address - Country:US
Practice Address - Phone:908-376-1529
Practice Address - Fax:908-634-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA606082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty