Healthcare Provider Details

I. General information

NPI: 1760461172
Provider Name (Legal Business Name): MICHAEL F LOSPINUSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 BROAD ST
RED BANK NJ
07701-2150
US

IV. Provider business mailing address

365 BROAD ST
RED BANK NJ
07701-2150
US

V. Phone/Fax

Practice location:
  • Phone: 732-933-4300
  • Fax: 732-933-1444
Mailing address:
  • Phone: 732-933-4300
  • Fax: 732-933-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA05259300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25MA05259300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: