Healthcare Provider Details

I. General information

NPI: 1164294005
Provider Name (Legal Business Name): WELL SPINE AND ORTHOPEDIC CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 MAIN AVE
CLIFTON NJ
07011-2333
US

IV. Provider business mailing address

1003 MAIN AVE
CLIFTON NJ
07011-2333
US

V. Phone/Fax

Practice location:
  • Phone: 917-376-9576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: SINA MENASHEHOFF
Title or Position: DO
Credential:
Phone: 917-376-9576