Healthcare Provider Details

I. General information

NPI: 1992259261
Provider Name (Legal Business Name): SPINE AND REHABILITATION CENTER OF THE ORANGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 CENTRAL AVE STE 302
EAST ORANGE NJ
07018-1943
US

IV. Provider business mailing address

576 CENTRAL AVE STE 302
EAST ORANGE NJ
07018-1943
US

V. Phone/Fax

Practice location:
  • Phone: 973-266-7860
  • Fax:
Mailing address:
  • Phone: 973-266-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL LATZA
Title or Position: MANAGER
Credential: DC
Phone: 908-322-8300