Basic Information
| Provider Information | |||||||||
| NPI: | 1215995030 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPINE AND PAIN CENTERS, P. A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1967 STATE ROUTE 34 STE 102 | ||||||||
| Address2: | |||||||||
| City: | WALL TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077199738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323451180 | ||||||||
| FaxNumber: | 7325304476 | ||||||||
| Practice Location | |||||||||
| Address1: | 1967 STATE ROUTE 34 STE 102 | ||||||||
| Address2: | |||||||||
| City: | WALL TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077199738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323451180 | ||||||||
| FaxNumber: | 7325304476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 04/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | DONALD | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7323451180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.