Healthcare Provider Details

I. General information

NPI: 1548766165
Provider Name (Legal Business Name): ORTHOPAEDIC AND SPINE INSTITUTE OF NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W CENTURY RD STE 300
PARAMUS NJ
07652-1435
US

IV. Provider business mailing address

30 W CENTURY RD STE 300
PARAMUS NJ
07652-1435
US

V. Phone/Fax

Practice location:
  • Phone: 516-775-8602
  • Fax:
Mailing address:
  • Phone: 516-775-8602
  • Fax: 201-793-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number22697
License Number StateNJ

VIII. Authorized Official

Name: MR. BRUCE JACOBSON
Title or Position: OWNER
Credential:
Phone: 201-793-8200