Provider Demographics
NPI:1013465947
Name:SPINE INSTITUTE OF NEW JERSEY LLC
Entity Type:Organization
Organization Name:SPINE INSTITUTE OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-925-1881
Mailing Address - Street 1:375 BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2294
Mailing Address - Country:US
Mailing Address - Phone:973-925-1881
Mailing Address - Fax:973-925-1884
Practice Address - Street 1:375 BROADWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2294
Practice Address - Country:US
Practice Address - Phone:973-925-1881
Practice Address - Fax:973-925-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00508400261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty