Provider Demographics
NPI:1114959087
Name:GREENBAUM, DENNIS M (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:M
Last Name:GREENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7200
Mailing Address - Country:US
Mailing Address - Phone:212-604-1824
Mailing Address - Fax:212-604-1892
Practice Address - Street 1:ST. VINCENTS HOSPITAL 153 WEST 11TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-604-8336
Practice Address - Fax:212-604-8061
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103854207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00180369Medicaid
NY00180369Medicaid
NYB80237Medicare UPIN