MEDICARE: ADVANCED SPINE CARE AND PHYSICAL REHABILITATION,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	7427430001	NJ
2	261QM1300X	Multi-Specialty Clinic/Center	MC05652	NJ

General Provider Information

NPI Number	:	1891816914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SPINE CARE AND PHYSICAL REHABILITATION,LLC

Provider Business Mailing Address
First Line	:	728 BENNETTS MILLS RD
Second Line	:	SUITE 1
City	:	JACKSON
State	:	NJ
Zip	:	08527-3850
Country	:	US
Telephone Number	:	732-415-1401
Fax Number	:	732-415-1403

Provider Business Practice Location Address
First Line	:	728 BENNETTS MILLS RD
Second Line	:	SUITE 1
City	:	JACKSON
State	:	NJ
Zip	:	08527-3850
Country	:	US
Telephone Number	:	732-415-1401
Fax Number	:	732-415-1403

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAMBROS R. LAMBROU
Credential	:	DC
Telephone Number	:	732-415-1401

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	03/25/2024

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