Provider Demographics
NPI:1407347875
Name:CENTER FOR THE FUNCTIONAL RESTORATION OF THE SPINE LLC
Entity type:Organization
Organization Name:CENTER FOR THE FUNCTIONAL RESTORATION OF THE SPINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-380-1212
Mailing Address - Street 1:1131 BROAD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4368
Mailing Address - Country:US
Mailing Address - Phone:732-380-1212
Mailing Address - Fax:732-380-1372
Practice Address - Street 1:1131 BROAD ST STE 201
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4368
Practice Address - Country:US
Practice Address - Phone:732-380-1212
Practice Address - Fax:732-380-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00662400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty