Provider Demographics
NPI:1982766259
Name:ORTHOPAEDIC SPINE INSTITUTE, PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPINE INSTITUTE, PA
Other - Org Name:ORTHOPAEDIC INSTITUTE SPINE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASSISTANT PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELESKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-974-0404
Mailing Address - Street 1:2315 ROUTE 34 SOUTH
Mailing Address - Street 2:SUITE D
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1444
Mailing Address - Country:US
Mailing Address - Phone:732-974-0404
Mailing Address - Fax:732-974-2653
Practice Address - Street 1:2315 ROUTE 34 SOUTH
Practice Address - Street 2:SUITE D
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1444
Practice Address - Country:US
Practice Address - Phone:732-974-0404
Practice Address - Fax:732-974-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty