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General NPI Number Information
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NPI Number | 1134572126
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Entity Type | Organization
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Legal Business Name | BRAIN AND SPINE INSTITUTE OF NY AND NJ
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 25 KENNEDY BLVD SUITE 850
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-1259
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Country | US
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Telephone | 732-241-0806
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Fax |
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Provider Business Mailing Address
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Address Line | 25 KENNEDY BOULEVARD SUITE 850
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone | 732-241-0806
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. MICHAEL A FALCON
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Credential |
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Telephone | 732-241-0806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 25MA08810500
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License Number State | NJ
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