Provider Demographics
NPI:1932477593
Name:SPINE AND SPORTS ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:SPINE AND SPORTS ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PONZINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-447-0346
Mailing Address - Street 1:197 E FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1553
Mailing Address - Country:US
Mailing Address - Phone:201-447-0346
Mailing Address - Fax:
Practice Address - Street 1:197 E FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1553
Practice Address - Country:US
Practice Address - Phone:201-447-0346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171100000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty