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General NPI Number Information
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NPI Number | 1801040027
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Entity Type | Organization
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Legal Business Name | SPINE EXPOSURE SPECIALISTS LLC
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 47 MAPLE STREET SUITE 407
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City | SUMMIT
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State | NJ
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Zip | 07901-2571
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Country | US
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Telephone | 908-376-1529
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Fax | 908-634-0323
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Provider Business Mailing Address
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Address Line | PO BOX 157
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City | SUMMIT
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State | NJ
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Zip | 07902-0151
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Country | US
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Telephone | 908-376-1529
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Fax | 908-634-0323
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | MRS. VICKY A HOFMEISTER
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Credential | CPC
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Telephone | 908-376-1529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MA60608
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License Number State | NJ
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