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  7. NPI Record 1174884530

INTERNATIONAL CENTER FOR MINIMALLY INVASIVE SPINE SURGERY, LLC
Complete NPI Record 1174884530
Clinic/Center - Ambulatory Surgical in Wyckoff, NJ

NPI Status: Active since June 01, 2012

Contact Information

461 GOFFLE RD
WYCKOFF, NJ
ZIP 07481
Phone: (201) 857-0720
Fax: (201) 857-0948

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Middle Name
  26. Authorized Official Title or Position
  27. Authorized Official Telephone Number
  28. Healthcare Provider Taxonomy Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Is Organization Subpart
  31. Authorized Official Name Prefix Text
  32. Authorized Official Credential Text

Complete NPI Dataset

This page represents the complete record for NPI 1174884530. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1174884530
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: INTERNATIONAL CENTER FOR MINIMALLY INVASIVE SPINE SURGERY, LLC
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 461 GOFFLE RD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: WYCKOFF
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NJ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 074813003
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2018570720
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 2018570948
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 461 GOFFLE RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: WYCKOFF
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NJ
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Practice Location Address Postal Code: 074813003
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Practice Location Address Country Code If outside U S : US
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address Telephone Number: 2018570720
The city name in the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 2018570948
The State code in the location of the provider being identified.
Provider Enumeration Date: 6/1/2012
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 2/15/2017
The country code in the location address of the provider being identified.
Authorized Official Last Name: QUARTARARO
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: LOUIS
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official Middle Name: G
The date that a record was last updated or changed.
Authorized Official Title or Position: MANAGING PARTNER
The code designating the provider’s gender if the provider is a person.
Authorized Official Telephone Number: 2018570720
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Taxonomy Code 1: 261QA1903X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: MR.
Authorized Official Credential Text: MD
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No