1326059098 NPI number — GREENBAUM, MD - WAGNER, MD

Table of content: (NPI 1326059098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326059098 NPI number — GREENBAUM, MD - WAGNER, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENBAUM, MD - WAGNER, MD
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:
Provider Other Organization Name Type Code:
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:
1326059098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 W 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10011-7200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-604-1824
Provider Business Mailing Address Fax Number:
212-604-1892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST VINCENTS HOSPITAL 170 WEST 12TH STREET
Provider Second Line Business Practice Location Address:
COLEMAN 1050 EAST
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-604-8336
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ASTIZ
Authorized Official First Name:
MARK
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF, CRITICAL CARE MEDICINE
Authorized Official Telephone Number:
212-604-8336

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CF6456 . This is a "RRMEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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