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General NPI Number Information
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NPI Number | 1831988245
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Entity Type | Organization
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Legal Business Name | PERSONAL SPINE & ORTHOPAEDICS, LLC
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 71 GLENWOOD RD
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1909
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Country | US
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Telephone | 609-922-0511
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Fax |
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Provider Business Mailing Address
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Address Line | 71 GLENWOOD RD
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1909
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Country | US
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Telephone | 609-922-0511
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JAY S. REIDLER
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Credential | MD, MPH
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Telephone | 609-922-0511
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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