Provider Demographics
NPI:1457410763
Name:NORTH JERSEY SPINE AND SPORTS, PC
Entity Type:Organization
Organization Name:NORTH JERSEY SPINE AND SPORTS, PC
Other - Org Name:ADVANCED CENTER FOR SPINE CARE,PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-843-8300
Mailing Address - Street 1:480 MARKET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5932
Mailing Address - Country:US
Mailing Address - Phone:201-843-8300
Mailing Address - Fax:201-843-7833
Practice Address - Street 1:480 MARKET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5932
Practice Address - Country:US
Practice Address - Phone:201-843-8300
Practice Address - Fax:201-843-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ225775Medicare PIN