Provider Demographics
NPI:1396126066
Name:SPINE CONSULT NJ PC
Entity type:Organization
Organization Name:SPINE CONSULT NJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GERLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-915-2151
Mailing Address - Street 1:506 5TH AVENUE #2FF
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215
Mailing Address - Country:US
Mailing Address - Phone:212-882-1110
Mailing Address - Fax:212-882-1120
Practice Address - Street 1:140 SYLVAN AVENUE
Practice Address - Street 2:
Practice Address - City:ENGELWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632
Practice Address - Country:US
Practice Address - Phone:212-882-1110
Practice Address - Fax:212-882-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0561177Medicaid