Provider Demographics
NPI:1497967251
Name:SPORT & SPINE OF REHAB MCLEAN PLLC
Entity Type:Organization
Organization Name:SPORT & SPINE OF REHAB MCLEAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-766-0300
Mailing Address - Street 1:9300 LIVINGSTON RD
Mailing Address - Street 2:STE 100
Mailing Address - City:FT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4914
Mailing Address - Country:US
Mailing Address - Phone:240-766-0300
Mailing Address - Fax:240-766-0304
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:STE 425
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:703-448-5799
Practice Address - Fax:240-766-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136310OtherMAMSI
3846233OtherAETNA HMO
611706800OtherDEPT OF LABOR
7229667OtherAETNA PPO
1060259OtherASHN CIGNA HMO
2136310OtherALLIANCE
672723OtherCIGNA PPO
2136310OtherMDIPA
2136310OtherOPTIMUM CHOICE
G746OtherBCBS OF NCA
2136310OtherMDIPA
=========OtherKAISER MID ATLANTIC
2136310OtherOPTIMUM CHOICE
=========OtherPHCS