Provider Demographics
NPI:1245660190
Name:SPINE AND HEALTH CARE CENTER OF THE AMBOYS
Entity type:Organization
Organization Name:SPINE AND HEALTH CARE CENTER OF THE AMBOYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LATZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-468-8280
Mailing Address - Street 1:533B NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3657
Mailing Address - Country:US
Mailing Address - Phone:732-468-8280
Mailing Address - Fax:732-468-8794
Practice Address - Street 1:533B NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3657
Practice Address - Country:US
Practice Address - Phone:732-468-8280
Practice Address - Fax:732-468-8794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1619036738OtherNPI
NJ1003949256OtherNPI
NJ1780709469OtherNPI
NJ1205056108OtherNPI
NJ1841447380OtherNPI