Provider Demographics
NPI:1093733859
Name:GREENWALD, JAMES L (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-464-4686
Mailing Address - Fax:315-464-7106
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:STE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-464-4686
Practice Address - Fax:315-464-7106
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY145822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00630933Medicaid
NY34820JMedicare PIN