Healthcare Provider Details

I. General information

NPI: 1821542192
Provider Name (Legal Business Name): SPINE AND REHABILITATION CENTER OF WEST NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KENNEDY BLVD W
WEST NEW YORK NJ
07093-1414
US

IV. Provider business mailing address

6000 KENNEDY BLVD W
WEST NEW YORK NJ
07093-1414
US

V. Phone/Fax

Practice location:
  • Phone: 201-758-0099
  • Fax: 201-758-2992
Mailing address:
  • Phone: 201-758-0099
  • Fax: 201-758-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JOHN LATZA
Title or Position: MANAGER
Credential: DC
Phone: 908-764-7704