Provider Demographics
NPI:1295097426
Name:SYNERGY JOINT & SPINE LLC
Entity type:Organization
Organization Name:SYNERGY JOINT & SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-267-5319
Mailing Address - Street 1:525 ROUTE 73 S STE 300
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9644
Mailing Address - Country:US
Mailing Address - Phone:856-267-5319
Mailing Address - Fax:856-267-5483
Practice Address - Street 1:525 ROUTE 73 S STE 300
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9644
Practice Address - Country:US
Practice Address - Phone:856-267-5319
Practice Address - Fax:856-267-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07631700208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94640Medicare UPIN