1265709893 NPI number — JOEL G. GREENSPAN, M.D. PC

Table of content: (NPI 1265709893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265709893 NPI number — JOEL G. GREENSPAN, M.D. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOEL G. GREENSPAN, M.D. PC
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:
1265709893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08850-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-738-1659
Provider Business Mailing Address Fax Number:
704-871-2127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
838 PELHAMDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801-1032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-738-1659
Provider Business Practice Location Address Fax Number:
704-871-2128
Provider Enumeration Date:
11/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GREENSPAN
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-738-1659

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  1380001 , 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: 138000-1 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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