Provider Demographics
NPI:1700944147
Name:WATERFRONT INSTITUTE FOR SPINE AND JOINT REHABILITATION
Entity Type:Organization
Organization Name:WATERFRONT INSTITUTE FOR SPINE AND JOINT REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:PODELL
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:201-840-1980
Mailing Address - Street 1:115 RIVER RD STE 901
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1080
Mailing Address - Country:US
Mailing Address - Phone:201-840-1980
Mailing Address - Fax:201-840-1987
Practice Address - Street 1:115 RIVER RD STE 901
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1080
Practice Address - Country:US
Practice Address - Phone:201-840-1980
Practice Address - Fax:201-840-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6495280001Medicare NSC