Provider Demographics
NPI:1003055385
Name:B GREENWALD MEDICAL, P.A.
Entity Type:Organization
Organization Name:B GREENWALD MEDICAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-546-9591
Mailing Address - Street 1:8929 SE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-5312
Mailing Address - Country:US
Mailing Address - Phone:772-546-9591
Mailing Address - Fax:772-546-9535
Practice Address - Street 1:8929 SE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-5312
Practice Address - Country:US
Practice Address - Phone:772-546-9591
Practice Address - Fax:772-546-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9562111N00000X
FLCH7238111N00000X
FLOS10065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076934OtherMEDICARE ID - TYPE UNSPECIFIED
PA102111Medicare UPIN