Healthcare Provider Details

I. General information

NPI: 1164062717
Provider Name (Legal Business Name): LELAND JAY SNAIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2020
Last Update Date: 04/09/2023
Certification Date: 04/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1898 SPRING RD SE
SMYRNA GA
30080-2559
US

IV. Provider business mailing address

150 E 69TH ST
NEW YORK NY
10021-5704
US

V. Phone/Fax

Practice location:
  • Phone: 516-996-0048
  • Fax:
Mailing address:
  • Phone: 516-996-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2332245
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: