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General NPI Number Information
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NPI Number | 1245660190
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Entity Type | Organization
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Legal Business Name | SPINE AND HEALTH CARE CENTER OF THE AMBOYS
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 533B NEW BRUNSWICK AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3657
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Country | US
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Telephone | 732-468-8280
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Fax | 732-468-8794
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Provider Business Mailing Address
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Address Line | 533B NEW BRUNSWICK AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3657
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Country | US
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Telephone | 732-468-8280
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Fax | 732-468-8794
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MICHAEL JOHN LATZA
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Credential | DC
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Telephone | 732-468-8280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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