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General NPI Number Information
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NPI Number | 1821981879
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Entity Type | Organization
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Legal Business Name | SPINE AND JOINT CARE OF NJ LLC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 1111 PAULISON AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-3600
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Country | US
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Telephone | 908-906-7813
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Fax |
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Provider Business Mailing Address
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Address Line | 3 SOMERSET LN # 500
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City | EDGEWATER
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State | NJ
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Zip | 07020-2419
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Country | US
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Telephone | 908-906-7813
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Fax | 908-906-7813
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Authorized Official
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Title or Position | PRESIDENT
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Name | ILANA ETELZON
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Credential |
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Telephone | 646-644-2481
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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