Provider Demographics
NPI:1104543198
Name:SPINE & JOINT SPECIALISTS LLC
Entity type:Organization
Organization Name:SPINE & JOINT SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CREDENTIALING DATA
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTHANN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KIRSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-641-6214
Mailing Address - Street 1:P.O. BOX 325
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-0325
Mailing Address - Country:US
Mailing Address - Phone:856-903-3331
Mailing Address - Fax:516-747-4783
Practice Address - Street 1:1401 MARLTON PIKE EAST SUITE 14
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2207
Practice Address - Country:US
Practice Address - Phone:856-903-3331
Practice Address - Fax:516-747-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty