Healthcare Provider Details

I. General information

NPI: 1336783471
Provider Name (Legal Business Name): INTERNATIONAL SPINE & SPORTS INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 MOUNT PLEASANT AVE STE 205
WEST ORANGE NJ
07052-2751
US

IV. Provider business mailing address

1200 ROUTE 22 STE 14
BRIDGEWATER NJ
08807-2943
US

V. Phone/Fax

Practice location:
  • Phone: 561-855-2828
  • Fax: 561-653-1979
Mailing address:
  • Phone: 855-586-2615
  • Fax: 973-564-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SCOTT KATZMAN
Title or Position: OWNER
Credential: MD
Phone: 561-855-2828