Provider Demographics
NPI:1881632461
Name:NEW JERSEY SPINE CENTER, PA
Entity Type:Organization
Organization Name:NEW JERSEY SPINE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-635-0800
Mailing Address - Street 1:40 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2431
Mailing Address - Country:US
Mailing Address - Phone:973-635-0800
Mailing Address - Fax:
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2431
Practice Address - Country:US
Practice Address - Phone:973-635-0800
Practice Address - Fax:973-635-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ528793Medicare PIN
NJ5377640001Medicare NSC