Provider Demographics
NPI:1053133710
Name:JERSEY SHORE SPINE LLC
Entity type:Organization
Organization Name:JERSEY SHORE SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:732-996-6643
Mailing Address - Street 1:20 CHERRY TREE FARM RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2251
Mailing Address - Country:US
Mailing Address - Phone:732-615-9420
Mailing Address - Fax:732-615-9427
Practice Address - Street 1:9 HOSPITAL DR STE B4
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6425
Practice Address - Country:US
Practice Address - Phone:732-615-9420
Practice Address - Fax:732-615-9427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center