Provider Demographics
NPI:1669185039
Name:ADVANCED SPINAL CARE OF MERIDEN LLC
Entity type:Organization
Organization Name:ADVANCED SPINAL CARE OF MERIDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINGOLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:203-237-6325
Mailing Address - Street 1:197 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-4024
Mailing Address - Country:US
Mailing Address - Phone:203-237-6325
Mailing Address - Fax:203-238-4757
Practice Address - Street 1:197 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-4024
Practice Address - Country:US
Practice Address - Phone:203-237-6325
Practice Address - Fax:203-238-4757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty