Provider Demographics
NPI:1689816746
Name:INTRALIGN NJ, PC
Entity type:Organization
Organization Name:INTRALIGN NJ, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CENTRAL BILLING OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-343-5500
Mailing Address - Street 1:12880 COMMODITY PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3101
Mailing Address - Country:US
Mailing Address - Phone:813-343-5500
Mailing Address - Fax:866-462-7445
Practice Address - Street 1:94 OLD SHORT HILLS ROAD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:813-343-5500
Practice Address - Fax:866-698-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty