1144208208 NPI number — ROBERT S GREENBAUM OD PLLC

Table of content: (NPI 1144208208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144208208 NPI number — ROBERT S GREENBAUM OD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT S GREENBAUM OD PLLC
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:
1144208208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 ROUTE 55
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGRANGEVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12540-5045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-473-0220
Provider Business Mailing Address Fax Number:
845-473-0140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 ROUTE 55
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGRANGEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12540-5045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-473-0220
Provider Business Practice Location Address Fax Number:
845-473-0140
Provider Enumeration Date:
01/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREENBAUM
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-473-0220

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  VUT4414 , 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: P2790040 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C2T801 . This is a "BXBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 325 . This is a "DAVIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: U794 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2144998 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 597014 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY4414 . This is a "EYE MED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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