Healthcare Provider Details

I. General information

NPI: 1194980094
Provider Name (Legal Business Name): ADVANCED SPINAL MEDICINE AND REHABILITATION SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 SUNSET STRIP STE 309
SUCCASUNNA NJ
07876-1362
US

IV. Provider business mailing address

66 SUNSET STRIP STE 309
SUCCASUNNA NJ
07876-1362
US

V. Phone/Fax

Practice location:
  • Phone: 973-584-4171
  • Fax:
Mailing address:
  • Phone: 973-584-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER FERRARO
Title or Position: PRESIDENT
Credential:
Phone: 973-584-4170