Provider Demographics
NPI:1881764421
Name:PREMIER SPINE & SPORTS REHABILITATION LLC
Entity type:Organization
Organization Name:PREMIER SPINE & SPORTS REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBIASI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-467-4444
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-0510
Mailing Address - Country:US
Mailing Address - Phone:973-467-4444
Mailing Address - Fax:973-467-4446
Practice Address - Street 1:750 MORRIS TPKE
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2614
Practice Address - Country:US
Practice Address - Phone:973-467-4444
Practice Address - Fax:973-467-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00025700171100000X
NJ25MA047709002084N0400X
NJ40QA00915800225100000X
NJ38MC004002800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID #
6233990001Medicare NSC