Provider Demographics
NPI:1134572126
Name:BRAIN AND SPINE INSTITUTE OF NY AND NJ
Entity type:Organization
Organization Name:BRAIN AND SPINE INSTITUTE OF NY AND NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-241-0806
Mailing Address - Street 1:25 KENNEDY BOULEVARD
Mailing Address - Street 2:SUITE 850
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-241-0806
Mailing Address - Fax:
Practice Address - Street 1:25 KENNEDY BLVD
Practice Address - Street 2:SUITE 850
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1259
Practice Address - Country:US
Practice Address - Phone:732-241-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08810500207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0251798Medicaid