Provider Demographics
NPI:1235790015
Name:NASSAU SPINE TECHNICAL LLC
Entity Type:Organization
Organization Name:NASSAU SPINE TECHNICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-743-9450
Mailing Address - Street 1:2594 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3253
Mailing Address - Country:US
Mailing Address - Phone:516-743-9450
Mailing Address - Fax:516-743-9451
Practice Address - Street 1:2594 8TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-3253
Practice Address - Country:US
Practice Address - Phone:516-743-9450
Practice Address - Fax:516-743-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03918421Medicaid