Provider Demographics
NPI:1124230966
Name:SPORT & SPINE REHAB OF COLUMBIA
Entity type:Organization
Organization Name:SPORT & SPINE REHAB OF COLUMBIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-964-0837
Mailing Address - Street 1:11418 LIVINGSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:FT. WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744
Mailing Address - Country:US
Mailing Address - Phone:410-964-0837
Mailing Address - Fax:
Practice Address - Street 1:10760 HICKORY RIDGE ROAD
Practice Address - Street 2:119
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-964-0837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2103322OtherOPTIMUM CHOICE
4535854OtherAETNA PPO
G921OtherBCBS OF NCA
3348462OtherAETNA HMO
200064OtherCIGNA PPO
200289OtherASHN CIGNA HMO
2103322OtherMAMSI
2103322OtherALLIANCE
2103322OtherMDIPA
KEG7SPOtherBCBS OF MD
=========OtherGOLDEN RULE
200064OtherCIGNA PPO
=========OtherUNITED HEALTH CARE