Provider Demographics
NPI:1851058556
Name:SPINE AND REHABILITATION CENTERS OF NEW JERSEY LLC
Entity Type:Organization
Organization Name:SPINE AND REHABILITATION CENTERS OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LATZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-558-9500
Mailing Address - Street 1:511 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-2202
Mailing Address - Country:US
Mailing Address - Phone:908-558-9500
Mailing Address - Fax:
Practice Address - Street 1:511 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2202
Practice Address - Country:US
Practice Address - Phone:908-558-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty