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General NPI Number Information
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NPI Number | 1265754832
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Entity Type | Organization
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Legal Business Name | SPECIALIZED SPINE SURGERY
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 835 CHANTICLEER DRIVE
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City | CHERRY HILL
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State | NJ
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Zip | 08003-4813
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Country | US
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Telephone | 856-451-9395
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Fax | 856-451-8615
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Provider Business Mailing Address
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Address Line | PO BOX 1752
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City | BRIDGETON
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State | NJ
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Zip | 08302-0472
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Country | US
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Telephone | 856-451-9395
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Fax | 856-451-8615
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Authorized Official
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Title or Position | DIRECTOR
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Name | HELEN G PILLA
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Credential |
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Telephone | 856-451-9395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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