Organization
SPRING SPA DEPOT CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARIS L SILEGA MD (PRESIDENT)
(862) 241-1800
Entity
Organization
Contact information
Practice address
6 GOBLE ST, NEWARK, NJ 07114-2702
(888) 412-0570
Mailing address
PO BOX 32534, NEWARK, NJ 07102-0934
(888) 412-0570
(862) 241-1800
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
—
NJ
320700000X
Physical Disabilities Residential Treatment Facility
—
NJ
332900000X
Non-Pharmacy Dispensing Site
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
964725290
DB
—
Enumeration date
04/24/2012
Last updated
04/24/2012
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