Healthcare Provider Details

I. General information

NPI: 1891816914
Provider Name (Legal Business Name): ADVANCED SPINE CARE AND PHYSICAL REHABILITATION,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 BENNETTS MILLS RD SUITE 1
JACKSON NJ
08527-3850
US

IV. Provider business mailing address

728 BENNETTS MILLS RD SUITE 1
JACKSON NJ
08527-3850
US

V. Phone/Fax

Practice location:
  • Phone: 732-415-1401
  • Fax: 732-415-1403
Mailing address:
  • Phone: 732-415-1401
  • Fax: 732-415-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberMC05652
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7427430001
License Number StateNJ

VIII. Authorized Official

Name: DR. LAMBROS R. LAMBROU
Title or Position: OWNER
Credential: DC
Phone: 732-415-1401