Provider Demographics
NPI:1366800120
Name:NEUROSPINE ASSOCIATES PC
Entity type:Organization
Organization Name:NEUROSPINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVANAND
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DOMINIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-727-7131
Mailing Address - Street 1:895 S ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5004
Mailing Address - Country:US
Mailing Address - Phone:717-727-7131
Mailing Address - Fax:717-980-5147
Practice Address - Street 1:895 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5004
Practice Address - Country:US
Practice Address - Phone:717-727-7131
Practice Address - Fax:717-980-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420830207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1477541456OtherNPI
PA1477541456OtherNPI
PA7580460001Medicare NSC