Provider Demographics
NPI:1194746461
Name:NEW JERSEY SPINAL CARE P A
Entity type:Organization
Organization Name:NEW JERSEY SPINAL CARE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-942-4449
Mailing Address - Street 1:601 HAMBURG TPKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2048
Mailing Address - Country:US
Mailing Address - Phone:973-942-4449
Mailing Address - Fax:973-942-6339
Practice Address - Street 1:601 HAMBURG TPKE
Practice Address - Street 2:SUITE 101
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2048
Practice Address - Country:US
Practice Address - Phone:973-942-4449
Practice Address - Fax:973-942-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6081430001Medicare NSC