Provider Demographics
NPI:1831467596
Name:NEW JERSEY INSTITUTE FOR COMPREHENSIVE SPINE CARE LLC
Entity type:Organization
Organization Name:NEW JERSEY INSTITUTE FOR COMPREHENSIVE SPINE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVAUGHNCARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-854-8274
Mailing Address - Street 1:25 ROCKWOOD PL STE 335
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4959
Mailing Address - Country:US
Mailing Address - Phone:877-854-8274
Mailing Address - Fax:201-947-0850
Practice Address - Street 1:25 ROCKWOOD PL STE 335
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4959
Practice Address - Country:US
Practice Address - Phone:877-854-8274
Practice Address - Fax:201-947-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty