Provider Demographics
NPI:1942502315
Name:LJ SPINE AND JOINT CARE
Entity Type:Organization
Organization Name:LJ SPINE AND JOINT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-874-9084
Mailing Address - Street 1:1270 ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2014
Mailing Address - Country:US
Mailing Address - Phone:201-874-9084
Mailing Address - Fax:
Practice Address - Street 1:1279 ROUTE 46
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4904
Practice Address - Country:US
Practice Address - Phone:973-794-4704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00631300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV02439Medicare UPIN
NJ085644Medicare PIN