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General NPI Number Information
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NPI Number | 1437587193
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Entity Type | Organization
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Legal Business Name | PERFORMANCE SPINE AND SPORTS MEDICINE OF BORDENTOWN, LLC
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 9500 K. JOHNSON BLVD
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City | BORDENTOWN
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State | NJ
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Zip | 08505-4400
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Country | US
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Telephone | 609-588-8600
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Fax | 609-588-8602
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Provider Business Mailing Address
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Address Line | 9500 K. JOHNSON BLVD
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City | BORDENTOWN
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State | NJ
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Zip | 08505-4400
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Country | US
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Telephone | 609-588-8600
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Fax | 609-588-8602
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Authorized Official
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Title or Position | MANAGER
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Name | JANICE DELELLIS
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Credential |
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Telephone | 609-588-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NJ
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