Provider Demographics
NPI:1730312786
Name:LASER SPINE INSTITUTE OF PENNSYLVANIA, LLC
Entity type:Organization
Organization Name:LASER SPINE INSTITUTE OF PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIEBUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-289-9613
Mailing Address - Street 1:656 E SWEDESFORD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1606
Mailing Address - Country:US
Mailing Address - Phone:813-289-9613
Mailing Address - Fax:813-418-4112
Practice Address - Street 1:656 E SWEDESFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1606
Practice Address - Country:US
Practice Address - Phone:813-289-9613
Practice Address - Fax:813-418-4112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LASER SPINE INSTITUTE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty