Healthcare Provider Details

I. General information

NPI: 1811404239
Provider Name (Legal Business Name): LINDEN SPORT AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S PARK AVE
LINDEN NJ
07036-1101
US

IV. Provider business mailing address

201 S PARK AVE
LINDEN NJ
07036-1101
US

V. Phone/Fax

Practice location:
  • Phone: 201-326-4833
  • Fax:
Mailing address:
  • Phone: 201-326-4833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. KASHAMBA BUSBY
Title or Position: BILLING MANAGER
Credential:
Phone: 973-392-8916