Modern Spine Institute LLC

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

Legal business name

MODERN SPINE INSTITUTE LLC

Practice address

1135 Clifton Ave Ste 208
Clifton, NJ 07013-3643

Phone

(862) 336-9696

Fax

(862) 336-9697

NPI assigned

Apr 3, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Grigory Goldberg, MD

Title

Sole MBR

Phone

(732) 804-1091

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1831941723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 CLIFTON AVE STE 208",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070133643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 CLIFTON AVE STE 208",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070133643",
            "telephone_number": "862-336-9696",
            "fax_number": "862-336-9697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN SPINE INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-03",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "GRIGORY",
        "authorized_official_title_or_position": "SOLE  MBR",
        "authorized_official_telephone_number": "732-804-1091",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Clifton, NJ by specialty
• Orthopaedic Surgery of the Spine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.