Provider Demographics
NPI:1295510352
Name:JERSEY JOINT SPINE & REGEN, LLC
Entity type:Organization
Organization Name:JERSEY JOINT SPINE & REGEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-643-0894
Mailing Address - Street 1:214 SANBORN AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2660
Mailing Address - Country:US
Mailing Address - Phone:732-858-6638
Mailing Address - Fax:732-858-6638
Practice Address - Street 1:12 US HIGHWAY 9 STE 108
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1575
Practice Address - Country:US
Practice Address - Phone:732-858-6638
Practice Address - Fax:732-858-6638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty