Basic Information
| Provider Information | |||||||||
| NPI: | 1568039402 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEWINGTON SPINE AND JOINT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 SHATTUCK WAY | ||||||||
| Address2: | |||||||||
| City: | NEWINGTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038018004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037816613 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 SHATTUCK WAY | ||||||||
| Address2: | |||||||||
| City: | NEWINGTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038018004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037816613 | ||||||||
| FaxNumber: | 6033363766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2021 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | KHALSA | ||||||||
| AuthorizedOfficialFirstName: | SATNARAYAN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6037816613 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT, DC | ||||||||
| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.