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Organization
SPRING SPA DEPOT CORPORATION
Active
Organization
SPRING SPA DEPOT CORPORATION
Active
Other names
Gaviota Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARIS L SILEGA M.D (PRESIDENT)
(973) 388-3258
Entity
Organization
Contact information
Practice address
123 CLIFFORD ST, NEWARK, NJ 07105-1950
(973) 388-3258
Mailing address
PO BOX 32534, NEWARK, NJ 07102-0934
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
302F00000X
Exclusive Provider Organization
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
04/30/2011
Last updated
04/30/2011
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