Healthcare Provider Details

I. General information

NPI: 1588992853
Provider Name (Legal Business Name): HEALTHSPINE AND ANESTHESIA INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 RIDGEDALE AVE STE 101C
CEDAR KNOLLS NJ
07927-2111
US

IV. Provider business mailing address

PO BOX 4
CEDAR KNOLLS NJ
07927-0004
US

V. Phone/Fax

Practice location:
  • Phone: 973-865-5111
  • Fax: 973-292-0772
Mailing address:
  • Phone: 973-865-5111
  • Fax: 973-292-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: TOMI T PRVULOVIC
Title or Position: OWNER
Credential: MD
Phone: 973-865-5111