Provider Demographics
NPI:1013245489
Name:SPECIALISTS OF THE SPINE, LLC
Entity Type:Organization
Organization Name:SPECIALISTS OF THE SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-744-7111
Mailing Address - Street 1:96 GATES AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042
Mailing Address - Country:US
Mailing Address - Phone:973-744-7111
Mailing Address - Fax:973-746-6634
Practice Address - Street 1:96 GATES AVENUE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-744-7111
Practice Address - Fax:973-746-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02551300207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1231308Medicaid
D98904Medicare UPIN
460706Medicare PIN