Organization
NASSAU SPINE INTRAOP MONITORING MEDICAL
Active
Parent organization
NASSAU SPINE TEACHNICAL LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
NASSAU SPINE TEACHNICAL LLC
Authorized official
DR. KANWARPAUL GREWAL DO (OWNER)
(516) 743-9450
Entity
Organization
Contact information
Practice address
900 FRANKLIN AVE, VALLEY STREAM, NY 11580-2145
(516) 743-9450
Mailing address
30 MERRICK AVE STE 103, EAST MEADOW, NY 11554-1580
(516) 743-9450
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03918421
—
NY
Enumeration date
12/02/2019
Last updated
12/17/2019
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