Provider Demographics
NPI:1831366285
Name:PRINCETON SPINE AND JOINT CENTER
Entity type:Organization
Organization Name:PRINCETON SPINE AND JOINT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACILOVIC COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-454-0760
Mailing Address - Street 1:601 EWING ST STE A2
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 EWING ST STE A2
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2767
Practice Address - Country:US
Practice Address - Phone:609-454-0760
Practice Address - Fax:609-454-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239688208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY239688OtherLICENSE