Provider Demographics
NPI:1770733362
Name:NEW JERSEY SPORTS & SPINE MEDICINE, P.C.
Entity type:Organization
Organization Name:NEW JERSEY SPORTS & SPINE MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANKAMAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-249-9400
Mailing Address - Street 1:1553 STATE HIGHWAY 27
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-249-9400
Mailing Address - Fax:732-249-9500
Practice Address - Street 1:1553 STATE HIGHWAY 27
Practice Address - Street 2:SUITE 2100
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-249-9400
Practice Address - Fax:732-249-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07887300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ132150Medicare PIN