Healthcare Provider Details

I. General information

NPI: 1760928030
Provider Name (Legal Business Name): SPINE CENTER AND ORTHOPEDIC REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GRAND AVE STE 1
ENGLEWOOD NJ
07631-4967
US

IV. Provider business mailing address

11 MARCOTTE LN
TENAFLY NJ
07670-2424
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-2277
  • 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: DR. ELIZABETH BAKER
Title or Position: OWNER
Credential:
Phone: 201-503-1900