Healthcare Provider Details

I. General information

NPI: 1821981879
Provider Name (Legal Business Name): SPINE AND JOINT CARE OF NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PAULISON AVE
CLIFTON NJ
07011-3600
US

IV. Provider business mailing address

3 SOMERSET LN # 500
EDGEWATER NJ
07020-2419
US

V. Phone/Fax

Practice location:
  • Phone: 908-906-7813
  • Fax:
Mailing address:
  • Phone: 908-906-7813
  • Fax: 908-906-7813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ILANA ETELZON
Title or Position: PRESIDENT
Credential:
Phone: 646-644-2481