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General NPI Number Information
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NPI Number | 1306756275
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Entity Type | Organization
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Legal Business Name | PRIME ORTHO & SPINE LLC
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Dates
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Enumeration Date | 09/11/2026
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Last Update Date | 09/11/2026
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Provider Practice Location Address
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Address Line | 342 HAMBURG TPKE STE 209
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City | WAYNE
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State | NJ
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Zip | 07470-2166
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Country | US
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Telephone | 954-751-4490
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 W SAMPLE RD STE 318
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City | DEERFIELD BEACH
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State | FL
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Zip | 33064-1342
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Country | US
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Telephone | 954-751-4490
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHATINA CANNON
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Credential |
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Telephone | 954-751-4490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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