Provider Demographics
NPI:1821328402
Name:SPINE & OSTEOARTHRITIS CENTER OF NJ, LLC
Entity Type:Organization
Organization Name:SPINE & OSTEOARTHRITIS CENTER OF NJ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-359-4400
Mailing Address - Street 1:7 RIDGEDALE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1120
Mailing Address - Country:US
Mailing Address - Phone:973-359-4400
Mailing Address - Fax:973-359-4414
Practice Address - Street 1:7 RIDGEDALE AVE STE 203
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1120
Practice Address - Country:US
Practice Address - Phone:973-359-4400
Practice Address - Fax:973-359-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00176600111NS0005X
NJ4507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55119Medicare UPIN
NJT99396Medicare UPIN