Healthcare Provider Details

I. General information

NPI: 1174612832
Provider Name (Legal Business Name): SPINE CENTER AND ORTHOPEDIC REHABILITATION OF ENGLEWOOD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
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

PO BOX 118
TENAFLY NJ
07670-0118
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-2277
  • Fax: 201-567-7506
Mailing address:
  • Phone: 201-503-1900
  • Fax: 201-503-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) 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: ELIZABETH A BAKER
Title or Position: PRESIDENT
Credential: MD
Phone: 201-503-1900