Healthcare Provider Details

I. General information

NPI: 1831467596
Provider Name (Legal Business Name): NEW JERSEY INSTITUTE FOR COMPREHENSIVE SPINE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PL STE 335
ENGLEWOOD NJ
07631-4959
US

IV. Provider business mailing address

25 ROCKWOOD PL STE 335
ENGLEWOOD NJ
07631-4959
US

V. Phone/Fax

Practice location:
  • Phone: 877-854-8274
  • Fax: 201-947-0850
Mailing address:
  • Phone: 877-854-8274
  • Fax: 201-947-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAWN LAVAUGHNCARRERO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 877-854-8274