Provider Demographics
NPI:1942379706
Name:SPINE AND PAIN CENTERS, PA
Entity Type:Organization
Organization Name:SPINE AND PAIN CENTERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-345-1180
Mailing Address - Street 1:655 SHREWSBURY AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4179
Mailing Address - Country:US
Mailing Address - Phone:732-345-1180
Mailing Address - Fax:732-345-8029
Practice Address - Street 1:1430 HOOPER AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2895
Practice Address - Country:US
Practice Address - Phone:732-473-9530
Practice Address - Fax:732-473-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5734860002Medicare NSC
NJ085014Medicare ID - Type Unspecified