Provider Demographics
NPI:1205073814
Name:ADVANCED SPINAL CARE & ASSOCIATES, LLC
Entity type:Organization
Organization Name:ADVANCED SPINAL CARE & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-300-0174
Mailing Address - Street 1:PO BOX 2266
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-2266
Mailing Address - Country:US
Mailing Address - Phone:973-300-0174
Mailing Address - Fax:973-300-1174
Practice Address - Street 1:380 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3556
Practice Address - Country:US
Practice Address - Phone:973-300-0174
Practice Address - Fax:973-300-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ151405Medicare PIN