Provider Demographics
NPI:1366569006
Name:SOMERSET SPINE & WELLNESS GROUP, PC
Entity type:Organization
Organization Name:SOMERSET SPINE & WELLNESS GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEATRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-252-9900
Mailing Address - Street 1:575 STATE ROUTE 28
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1354
Mailing Address - Country:US
Mailing Address - Phone:908-252-9900
Mailing Address - Fax:
Practice Address - Street 1:575 STATE ROUTE 28
Practice Address - Street 2:SUITE 207
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1354
Practice Address - Country:US
Practice Address - Phone:908-252-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty