Provider Demographics
NPI:1174039929
Name:CENTRAL NEW YORK BRAIN & SPINE NEUROSURGERY PLLC
Entity Type:Organization
Organization Name:CENTRAL NEW YORK BRAIN & SPINE NEUROSURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:QANDAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-767-2223
Mailing Address - Street 1:83 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2472
Mailing Address - Country:US
Mailing Address - Phone:315-792-7629
Mailing Address - Fax:315-266-1326
Practice Address - Street 1:83 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2472
Practice Address - Country:US
Practice Address - Phone:315-792-7629
Practice Address - Fax:315-266-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty