Minimally Invasive and Regenerative Spine Institute

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA06129800 Issued in NJ

Legal business name

MINIMALLY INVASIVE AND REGENERATIVE SPINE INSTITUTE

Practice address

1054 Clifton Ave
Clifton, NJ 07013-3638

Phone

(973) 779-4100

NPI assigned

Sep 8, 2015

Last updated

Sep 8, 2015By 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

Tomi Prvulovic, M.D.

Title

Sole MBR

Phone

(973) 903-4943

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Mohamed Ali Boukheir, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Madison, NJ
  • NPI 1518351964
  NPD (past)
• Imad Tamimi, D.M.D

  • Oral and Maxillofacial Surgery (Dentist)
  • Clifton, NJ
  • NPI 1659669091
  NPD (past)

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

{
    "created_epoch": "1441670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441670400000",
    "number": "1063880011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1054 CLIFTON AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070133638",
            "telephone_number": "973-779-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1054 CLIFTON AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070133638",
            "telephone_number": "973-779-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINIMALLY INVASIVE AND REGENERATIVE SPINE INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-08",
        "last_updated": "2015-09-08",
        "status": "A",
        "authorized_official_last_name": "PRVULOVIC",
        "authorized_official_first_name": "TOMI",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "973-903-4943",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA06129800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Weisser Millien
• Ted Min
• Noeli Minaya Pereyra, DMD
• Mindcare Plus
• Cherry Ann A Mineses, PT, DPT
• Mira Vie at Clifton Opco LLC (Mira Vie at Clifton)
• Miriam Adler PC
• Ashley Lynn Mistak, LPC
• Darshanabahen J Mistry, NP
• Chana Mittel

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2015; 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.