# SPRING SPA DEPOT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083972442
- **Authorized official:** DR. GARIS L SILEGA MD (PRESIDENT)
- **Authorized official phone:** (862) 241-1800

## Contact information

- **Practice address:** 6 GOBLE ST, NEWARK, NJ 07114-2702
- **Practice address phone:** (888) 412-0570
- **Mailing address:** PO BOX 32534, NEWARK, NJ 07102-0934
- **Mailing address phone:** (888) 412-0570
- **Mailing address fax:** (862) 241-1800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 305R00000X | Preferred Provider Organization | — | NJ | — |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NJ | — |
| 332900000X | Non-Pharmacy Dispensing Site | — | NJ | Yes |

## Other

- **Enumeration date:** 04/24/2012
- **Last updated:** 04/24/2012