Provider Demographics
NPI:1821395781
Name:NEW JERSEY SPINE & DISC CENTER,LLC
Entity Type:Organization
Organization Name:NEW JERSEY SPINE & DISC CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LAWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-383-8207
Mailing Address - Street 1:180 WHITE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1166
Mailing Address - Country:US
Mailing Address - Phone:732-383-8207
Mailing Address - Fax:732-387-5809
Practice Address - Street 1:180 WHITE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1166
Practice Address - Country:US
Practice Address - Phone:732-383-8207
Practice Address - Fax:732-387-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00667900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty