Provider Demographics
NPI:1235206475
Name:GREENSPAN, JOEL GARY (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:GARY
Last Name:GREENSPAN
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:PO BOX 5938
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-5938
Mailing Address - Country:US
Mailing Address - Phone:866-326-3056
Mailing Address - Fax:844-239-4823
Practice Address - Street 1:828 PELHAMDALE AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-1024
Practice Address - Country:US
Practice Address - Phone:800-738-1659
Practice Address - Fax:704-871-2127
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51A971Medicare ID - Type UnspecifiedPROVIDER #