NPIMap

Organization Active NPI

North Jersey Interventional Spine Center, LLC

  • Specialist
  • Wayne, NJ
National Provider Identifier
1184035420
Registry record updated Feb 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25MA08735700 Issued in NJ
Legal business name
NORTH JERSEY INTERVENTIONAL SPINE CENTER, LLC
Practice address
601 Hamburg Tpke
Suite 204
Wayne, NJ 07470-2048
Phone
(862) 248-0668
Fax
(862) 248-0669
NPI assigned
May 8, 2014
Last updated
Feb 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2015

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

Authorized official

Name
Dr. David M Bandola, MDNPI 1487827408
Title
MD
Phone
(862) 248-0668

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 25MA08735700 NJ Primary

Addresses

Primary practice location

601 Hamburg Tpke
Suite 204
Wayne, NJ 07470-2048

Mailing address

601 Hamburg Tpke
Suite 204
Wayne, NJ 07470-2048
Phone (862) 248-0668

Other identifiers 1

IdentifierTypeStateIssuer
25MA08735700OtherNJMEDICAL LICENSE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1399507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424822400000",
    "number": "1184035420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 HAMBURG TPKE",
            "address_2": "SUITE 204",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702048",
            "telephone_number": "862-248-0668",
            "fax_number": "862-248-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 HAMBURG TPKE",
            "address_2": "SUITE 204",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702048",
            "telephone_number": "862-248-0668",
            "fax_number": "862-248-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH JERSEY INTERVENTIONAL SPINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-08",
        "last_updated": "2015-02-25",
        "status": "A",
        "authorized_official_last_name": "BANDOLA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "862-248-0668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA08735700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "25MA08735700",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 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.