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General NPI Number Information
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NPI Number | 1427302512
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE SPINE & ORTHOPEDIC REHABILITATION
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 1 GREENWOOD AVE SUITE #100
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3649
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Country | US
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Telephone | 973-746-2424
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Fax | 973-746-5030
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Provider Business Mailing Address
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Address Line | 1 GREENWOOD AVE SUITE #100
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3649
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Country | US
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Telephone | 973-746-2424
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Fax | 973-746-5030
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ALICIA RUSSELL CARTER
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Credential | M.D.
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Telephone | 973-746-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 25MA07029200
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License Number State | NJ
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