Organization
EXECUTIVE SPINE SURGERY PC
Active
Organization
EXECUTIVE SPINE SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. IRINA KAMENETSKIY (ADMINITRATOR)
(917) 697-5558
Entity
Organization
Contact information
Practice address
157 HIGH ST, NEWTON, NJ 07860-1004
(908) 452-5612
(908) 452-5624
Mailing address
157 HIGH ST, NEWTON, NJ 07860-1004
(908) 452-5612
(908) 452-5624
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
25MA09005200
NJ
Other
Enumeration date
04/23/2012
Last updated
02/09/2021
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