Provider Demographics
NPI:1811385859
Name:SPINE SURGERY ASSOCIATES & DISCOVERY IMAGING PC
Entity Type:Organization
Organization Name:SPINE SURGERY ASSOCIATES & DISCOVERY IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:VESSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-532-0576
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:PLUCKEMIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07978-0323
Mailing Address - Country:US
Mailing Address - Phone:908-532-0576
Mailing Address - Fax:908-532-0578
Practice Address - Street 1:1 ROBERTSON DR
Practice Address - Street 2:SUITE 11
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1716
Practice Address - Country:US
Practice Address - Phone:908-532-0576
Practice Address - Fax:908-532-0578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINE SURGERY ASSOCIATES & DISCOVERY IMAGING PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68160174400000X
NJ25MA05026500207XS0117X
NJ25MA05758800208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty