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General NPI Number Information
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NPI Number | 1821394503
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Entity Type | Organization
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Legal Business Name | NEURO ENDO-SPINE, LLC
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 1030 KINGS HWY N SUITE 200
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City | CHERRY HILL
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State | NJ
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Zip | 08034-1907
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Country | US
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Telephone | 856-779-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 388 LAKEHURST RD
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City | TOMS RIVER
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State | NJ
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Zip | 08755-7340
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Country | US
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Telephone | 732-341-2822
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMUEL DAVID SCHENKER
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Credential | MD
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Telephone | 732-341-2822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 25MA04118800
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License Number State | NJ
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