1184950933 NPI number — RICHARD S. GREENBAUM PHD, PA

Table of content: (NPI 1184950933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184950933 NPI number — RICHARD S. GREENBAUM PHD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD S. GREENBAUM PHD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RICHARD S. GREENBAUM PHD, PA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184950933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1175 N.E. 125 ST.
Provider Second Line Business Mailing Address:
#201
Provider Business Mailing Address City Name:
NO. MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33161-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-891-4821
Provider Business Mailing Address Fax Number:
305-891-4271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1175 N.E. 125 ST.
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
NO. MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33161-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-891-4821
Provider Business Practice Location Address Fax Number:
305-891-4271
Provider Enumeration Date:
10/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREENBAUM
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-891-4821

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY2247 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)