Provider Demographics
NPI:1952095176
Name:ATLANTIC BRAIN AND SPINE LLC
Entity Type:Organization
Organization Name:ATLANTIC BRAIN AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, AMBULATORY VENTURES
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-971-7225
Mailing Address - Street 1:465 SOUTH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6439
Mailing Address - Country:US
Mailing Address - Phone:973-971-7225
Mailing Address - Fax:973-898-3905
Practice Address - Street 1:465 SOUTH ST STE 200
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6439
Practice Address - Country:US
Practice Address - Phone:973-971-7225
Practice Address - Fax:973-898-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty