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General NPI Number Information
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NPI Number | 1821328402
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Entity Type | Organization
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Legal Business Name | SPINE & OSTEOARTHRITIS CENTER OF NJ, LLC
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 7 RIDGEDALE AVE STE 203
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City | CEDAR KNOLLS
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State | NJ
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Zip | 07927-1120
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Country | US
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Telephone | 973-359-4400
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Fax | 973-359-4414
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Provider Business Mailing Address
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Address Line | 7 RIDGEDALE AVE STE 203
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City | CEDAR KNOLLS
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State | NJ
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Zip | 07927-1120
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Country | US
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Telephone | 973-359-4400
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Fax | 973-359-4414
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Authorized Official
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Title or Position | PARTNER
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Name | DR. LARRY A GOLDFARB
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Credential | D.C.
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Telephone | 973-359-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 38MC00176600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4507
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License Number State | NJ
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