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Organization
MOUNTAIN SPINE & ORTHOPEDICS LLC
Active
Organization
MOUNTAIN SPINE & ORTHOPEDICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY M. LEGG (CREDENTIALING)
(347) 584-8903
Entity
Organization
Contact information
Practice address
375 MOUNT PLEASANT AVE STE 205, WEST ORANGE, NJ 07052-2751
(973) 376-6595
Mailing address
375 MOUNT PLEASANT AVE STE 205, WEST ORANGE, NJ 07052-2751
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376590646
INDIVIDUAL NPI NUMBER
NJ
Enumeration date
05/06/2020
Last updated
05/06/2020
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