1174583686 NPI number — DR. FREDERICK GREENSTEIN M.D.

Table of content: DR. FREDERICK GREENSTEIN M.D. (NPI 1174583686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174583686 NPI number — DR. FREDERICK GREENSTEIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENSTEIN
Provider First Name:
FREDERICK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1174583686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BROOKDALE PLZ STE 666
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11212-3198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-240-7143
Provider Business Mailing Address Fax Number:
718-240-5808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE BROOKDALE PLAZA
Provider Second Line Business Practice Location Address:
MEN'S HEALTH - SUITE 500
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11212-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-240-8672
Provider Business Practice Location Address Fax Number:
718-240-5808
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  134704 , 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: 00715013 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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