Provider Demographics
NPI:1164906343
Name:GREENSTONE, JAY ALAN
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ALAN
Last Name:GREENSTONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2472 MCCLURES CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:VA
Mailing Address - Zip Code:24281-8710
Mailing Address - Country:US
Mailing Address - Phone:276-346-7235
Mailing Address - Fax:
Practice Address - Street 1:208 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2854
Practice Address - Country:US
Practice Address - Phone:276-546-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002719225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist