Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2332245 | NJ |
NPI | 1164062717 |
---|---|
Provider Name | Leland Jay Snaider |
First Address | New York, NY 10021-5704 |
Second Address | West Berlin, NJ 08091-9146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2020 |
Last Update Date | 12/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
387886545 | LICENSE (01) | NY |