Provider Demographics
NPI:1588763114
Name:SPINE CARE AND REHABILITATION, INC.
Entity type:Organization
Organization Name:SPINE CARE AND REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOPACZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-226-2725
Mailing Address - Street 1:200 SO. ORANGE AVE
Mailing Address - Street 2:SUITE 180 ANNEX
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-226-2725
Mailing Address - Fax:973-226-3270
Practice Address - Street 1:200 SO. ORANGE AVE
Practice Address - Street 2:SUITE 180 ANNEX
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-226-2725
Practice Address - Fax:973-226-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-04-08
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
115006600OtherUS DEPT OF LABOR
CL40186OtherOXFORD
024899Medicare UPIN