Healthcare Provider Details

I. General information

NPI: 1689816860
Provider Name (Legal Business Name): PERFORMANCE SPINE & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 QUAKERBRIDGE RD STE 206
HAMILTON NJ
08619-1288
US

IV. Provider business mailing address

PO BOX 649842
DALLAS TX
75264-9842
US

V. Phone/Fax

Practice location:
  • Phone: 609-588-8600
  • Fax: 609-588-8602
Mailing address:
  • Phone: 609-588-8600
  • Fax: 609-588-8602

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 Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER ROSE HEPLER
Title or Position: LEAD FINANCIAL REPRESENTATIVE
Credential: CPC
Phone: 346-308-6741