Provider Demographics
NPI:1841659026
Name:SPINE AND WELLNESS CENTER OF PATERSON PC
Entity type:Organization
Organization Name:SPINE AND WELLNESS CENTER OF PATERSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPALEONARDOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-684-1005
Mailing Address - Street 1:PO BOX 2348
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-9148
Mailing Address - Country:US
Mailing Address - Phone:973-684-1005
Mailing Address - Fax:973-684-1006
Practice Address - Street 1:515 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2338
Practice Address - Country:US
Practice Address - Phone:973-684-1005
Practice Address - Fax:973-684-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00541700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ034948Medicare PIN