Provider Demographics
NPI:1831498518
Name:SPINE MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:SPINE MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPHYSIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SILVERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC,CNIM,
Authorized Official - Phone:631-617-6011
Mailing Address - Street 1:140 ADAMS AVE
Mailing Address - Street 2:STE B-13
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3618
Mailing Address - Country:US
Mailing Address - Phone:631-617-6011
Mailing Address - Fax:631-617-6023
Practice Address - Street 1:140 ADAMS AVE
Practice Address - Street 2:STE B-13
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3618
Practice Address - Country:US
Practice Address - Phone:631-617-6011
Practice Address - Fax:631-617-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0400X, 2084N0600X
NY1184246ZE0600X
NY659246ZE0600X
NY200246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty