Provider Demographics
NPI:1235380338
Name:GEENBAUM, BARRY CLYDE
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:CLYDE
Last Name:GEENBAUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BARRY
Other - Middle Name:CLYDE
Other - Last Name:GREENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:555 KAPPOCK STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-549-8765
Mailing Address - Fax:
Practice Address - Street 1:555 KAPPOCK ST APT 4P
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6403
Practice Address - Country:US
Practice Address - Phone:718-549-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor