Provider Demographics
NPI:1174612832
Name:SPINE CENTER AND ORTHOPEDIC REHABILITATION OF ENGLEWOOD, PC
Entity type:Organization
Organization Name:SPINE CENTER AND ORTHOPEDIC REHABILITATION OF ENGLEWOOD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-503-1900
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-0118
Mailing Address - Country:US
Mailing Address - Phone:201-503-1900
Mailing Address - Fax:201-503-1901
Practice Address - Street 1:500 GRAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4967
Practice Address - Country:US
Practice Address - Phone:201-567-2277
Practice Address - Fax:201-567-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2081S0010X, 2081P2900X
NJ25MA05923000261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095526Medicare ID - Type UnspecifiedBILLING ID