Provider Demographics
NPI:1083979645
Name:GREENWALD, BROCHA (TEACHER)
Entity Type:Individual
Prefix:MRS
First Name:BROCHA
Middle Name:
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:BROCHA
Other - Middle Name:
Other - Last Name:GREENWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 OCEAN PKWY
Mailing Address - Street 2:APT 4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1180
Mailing Address - Country:US
Mailing Address - Phone:347-623-0117
Mailing Address - Fax:
Practice Address - Street 1:6002 FARRAGUT RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3125
Practice Address - Country:US
Practice Address - Phone:718-943-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist