New Jersey Spine & Sport Rehabilitation Medicine LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA09845900 Issued in NJ

Legal business name

NEW JERSEY SPINE & SPORT REHABILITATION MEDICINE LLC

Practice address

129 Newark Ave
Jersey City, NJ 07302-2811

Phone

(718) 794-0600

NPI assigned

Jul 25, 2017

Last updated

Jul 25, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sireen M Gopal, MDNPI 1720183551

Title

MD

Phone

(718) 794-0600

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sireen M Gopal, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Bronx, NY
  • NPI 1720183551
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500940800000",
    "number": "1033632765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 EASTCHESTER RD STE A",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612252",
            "telephone_number": "718-794-0600",
            "fax_number": "718-794-9899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 NEWARK AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073022811",
            "telephone_number": "718-794-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW JERSEY SPINE & SPORT REHABILITATION MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-25",
        "last_updated": "2017-07-25",
        "status": "A",
        "authorized_official_last_name": "GOPAL",
        "authorized_official_first_name": "SIREEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "718-794-0600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA09845900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Jersey City, NJ
• Providers in Jersey City, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.