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General NPI Number Information
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NPI Number | 1487729687
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR SPINE & SCOLIOSIS PA
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 3100 PRINCETON PIKE BLDG 1
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648
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Country | US
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Telephone | 609-912-1500
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Fax | 609-912-1600
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Provider Business Mailing Address
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Address Line | 3100 PRINCETON PIKE BLDG 1
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648
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Country | US
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Telephone | 609-912-1500
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Fax | 609-912-1600
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARK DARRYL ANTONACCI
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Credential | SPINE SURGEON MD
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Telephone | 609-912-1500
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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 | MD068759L
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License Number State | PA
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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 | 213845-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 25MA06999100
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License Number State | NJ
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