# MOUNTAIN SPINE & ORTHOPEDICS LLC

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

## Provider details

- **NPI number:** 1659992139
- **Authorized official:** MARY M. LEGG (CREDENTIALING)
- **Authorized official phone:** (347) 584-8903

## Contact information

- **Practice address:** 375 MOUNT PLEASANT AVE STE 205, WEST ORANGE, NJ 07052-2751
- **Practice address phone:** (973) 376-6595
- **Mailing address:** 375 MOUNT PLEASANT AVE STE 205, WEST ORANGE, NJ 07052-2751

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/06/2020
- **Last updated:** 05/06/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1376590646 | INDIVIDUAL NPI NUMBER | NJ |