| NPI | 1689003196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY JACOB President 516-587-3406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: NJ MA067801) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00294500) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2016-06-03 |