Provider Demographics
NPI:1649594144
Name:CLIFTON SPINE & INJURY CENTER, LLC
Entity type:Organization
Organization Name:CLIFTON SPINE & INJURY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-261-7534
Mailing Address - Street 1:1117 MAIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2379
Mailing Address - Country:US
Mailing Address - Phone:973-470-0100
Mailing Address - Fax:973-405-6088
Practice Address - Street 1:1117 MAIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2379
Practice Address - Country:US
Practice Address - Phone:973-470-0100
Practice Address - Fax:973-405-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
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