Provider Demographics
NPI:1982316824
Name:GREENLEAF NEURO TECHNOLOGY, INC
Entity Type:Organization
Organization Name:GREENLEAF NEURO TECHNOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-426-3760
Mailing Address - Street 1:1101 GROVE LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5644
Mailing Address - Country:US
Mailing Address - Phone:888-851-3677
Mailing Address - Fax:888-851-3671
Practice Address - Street 1:1101 GROVE LN
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5644
Practice Address - Country:US
Practice Address - Phone:888-851-3677
Practice Address - Fax:888-851-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty