Provider Demographics
NPI:1215429782
Name:SHEN SPINE
Entity type:Organization
Organization Name:SHEN SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-638-8886
Mailing Address - Street 1:150 MAPLE AVE SUITE 168
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-3407
Mailing Address - Country:US
Mailing Address - Phone:732-638-8886
Mailing Address - Fax:732-626-6593
Practice Address - Street 1:136 WOODBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904
Practice Address - Country:US
Practice Address - Phone:732-638-8886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty