Healthcare Provider Details

I. General information

NPI: 1255779112
Provider Name (Legal Business Name): COMPREHENSIVE SPINAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 TERRACE AVE FL 4
HASBROUCK HEIGHTS NJ
07604-3107
US

IV. Provider business mailing address

40 SE 5TH ST STE 406
BOCA RATON FL
33432-6003
US

V. Phone/Fax

Practice location:
  • Phone: 866-477-1126
  • Fax: 201-815-2002
Mailing address:
  • Phone: 866-477-1126
  • Fax: 201-828-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25MA09297900
License Number StateNJ

VIII. Authorized Official

Name: MR. ERIC WEINBERGER
Title or Position: CEO
Credential:
Phone: 561-801-3971