Provider Demographics
NPI:1811421696
Name:PRECISION SPINE & SPORTS MEDICINE
Entity Type:Organization
Organization Name:PRECISION SPINE & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKHOLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-762-6143
Mailing Address - Street 1:1306 AARON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1005
Mailing Address - Country:US
Mailing Address - Phone:732-422-3400
Mailing Address - Fax:732-422-8848
Practice Address - Street 1:1346 HOW LN STE 107
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1728
Practice Address - Country:US
Practice Address - Phone:732-422-3400
Practice Address - Fax:732-422-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty