Healthcare Provider Details

I. General information

NPI: 1063537470
Provider Name (Legal Business Name): NEW JERSEY BRAIN & SPINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 FROM RD STE 220
PARAMUS NJ
07652-3551
US

IV. Provider business mailing address

650 FROM RD STE 220
PARAMUS NJ
07652-3551
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-2550
  • Fax: 201-342-7171
Mailing address:
  • Phone: 201-342-2550
  • Fax: 201-342-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: VIA A TZIAGAS
Title or Position: BILLING MANAGER
Credential:
Phone: 201-342-2550