OrganizationActive
Executive Spine Surgery PC
NPI 1164789582 · Neurological Surgery Physician · Newton, NJ
Provider details
- NPI number
- 1164789582
- Entity type
- Organization
- Primary specialty
- Neurological Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Irina Kamenetskiy, Adminitrator(917) 697-5558
- License
- 25MA09005200 (NJ)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(80/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
157 High St
Newton, NJ 07860-1004
Phone: (908) 452-5612
Fax: (908) 452-5624
Street-level locationGet directions
Mailing address
157 High St
Newton, NJ 07860-1004
Registry dates
- Enumerated
- 2012-04-23
- Last updated
- 2021-02-09
- Certified
- 2021-02-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.