Healthcare Provider Details

I. General information

NPI: 1437512514
Provider Name (Legal Business Name): NEW CENTURY SPINE AND OUTPATIENT SURGICAL INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W CENTURY RD SUITE 106
PARAMUS NJ
07652-1466
US

IV. Provider business mailing address

37 W CENTURY RD SUITE 106
PARAMUS NJ
07652-1466
US

V. Phone/Fax

Practice location:
  • Phone: 201-986-1003
  • Fax: 201-986-1680
Mailing address:
  • Phone: 201-986-1003
  • Fax: 201-986-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. THOMAS P RAGUKONIS
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 201-986-1003