Provider Demographics
NPI:1275760175
Name:KEIRON GREAVES, MD PC
Entity Type:Organization
Organization Name:KEIRON GREAVES, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KEIRON
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-918-8312
Mailing Address - Street 1:PO BOX 24230
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101
Mailing Address - Country:US
Mailing Address - Phone:732-918-8312
Mailing Address - Fax:914-591-8362
Practice Address - Street 1:317 ROUTE 34 STE 323
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2446
Practice Address - Country:US
Practice Address - Phone:732-918-8312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ579614Medicare PIN