NPIMap

Organization Active NPI

Northeast Spine & Wellness Center LLC

  • Specialist
  • Clark, NJ
National Provider Identifier
1588798409
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
NORTHEAST SPINE & WELLNESS CENTER LLC
Practice address
1043 Raritan Rd
Clark, NJ 07066-1316
Phone
(732) 827-0800
Fax
(732) 827-0826
NPI assigned
Mar 15, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Scot David Paris, M.D.NPI 1710960752
Title
Owner
Phone
(732) 827-0800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X NJ Primary

Addresses

Primary practice location

1043 Raritan Rd
Clark, NJ 07066-1316

Mailing address

1043 Raritan Rd
Clark, NJ 07066-1316
Phone (732) 827-0800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080329000017 NJ Part B Supplier - Clinic/Group Practice 1951487016 Receives reassigned benefits from 12 practitioners
Practice locations: Clark, NJ
O20100930095027 NJ DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Physician - Family Practice 1951487016 Practice locations: Clark, NJ

National Provider Directory

National Provider Directory

Locations

1043 Raritan Rd
Clark, NJ 07066
Phone (732) 382-3300

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1588798409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043 RARITAN RD",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661316",
            "telephone_number": "732-827-0800",
            "fax_number": "732-827-0826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1043 RARITAN RD",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661316",
            "telephone_number": "732-827-0800",
            "fax_number": "732-827-0826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST SPINE & WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PARIS",
        "authorized_official_first_name": "SCOT",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-827-0800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.