Provider Demographics
NPI:1164062717
Name:SNAIDER, LELAND JAY
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:JAY
Last Name:SNAIDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 69TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5704
Mailing Address - Country:US
Mailing Address - Phone:516-996-0048
Mailing Address - Fax:
Practice Address - Street 1:1898 SPRING RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2559
Practice Address - Country:US
Practice Address - Phone:516-996-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-12
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2332245111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY387886545OtherLICENSE