Provider Demographics
NPI:1063550085
Name:SPINE & ORTHOPAEDIC PHYSICAL THERAPY CENTER OF NEW JERSEY, PA
Entity type:Organization
Organization Name:SPINE & ORTHOPAEDIC PHYSICAL THERAPY CENTER OF NEW JERSEY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PREVITE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT CERT MDT
Authorized Official - Phone:908-725-9595
Mailing Address - Street 1:390 AMWELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1226
Mailing Address - Country:US
Mailing Address - Phone:908-725-9595
Mailing Address - Fax:908-725-9803
Practice Address - Street 1:390 AMWELL RD STE 101
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1226
Practice Address - Country:US
Practice Address - Phone:908-725-9595
Practice Address - Fax:908-725-9803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091001Medicare PIN