Provider Demographics
NPI:1265991772
Name:INTERVENTIONAL SPINE AND SURGERY GROUP, LLC
Entity type:Organization
Organization Name:INTERVENTIONAL SPINE AND SURGERY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-430-2022
Mailing Address - Street 1:8901 KENNEDY BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5344
Mailing Address - Country:US
Mailing Address - Phone:201-243-2022
Mailing Address - Fax:
Practice Address - Street 1:8901 KENNEDY BLVD FL 1
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5344
Practice Address - Country:US
Practice Address - Phone:201-243-2022
Practice Address - Fax:201-243-7261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty