Provider Demographics
NPI:1346282803
Name:TIMOTHY J. GREENAN, M.D. P.C.
Entity Type:Organization
Organization Name:TIMOTHY J. GREENAN, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREENAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-692-9730
Mailing Address - Street 1:779 ROUTE 211 E
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1459
Mailing Address - Country:US
Mailing Address - Phone:845-692-9730
Mailing Address - Fax:845-692-9746
Practice Address - Street 1:779 ROUTE 211 E
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1459
Practice Address - Country:US
Practice Address - Phone:845-692-9730
Practice Address - Fax:845-692-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCH9051OtherMEDICARE RAILROAD
NYCJ2263OtherMEDICARE RAILROAD
PA001873220Medicaid
NY02760456Medicaid
NYCJ2260OtherMEDICARE RAILROAD
NYAA0940Medicare PIN
NYCH9051OtherMEDICARE RAILROAD
PA001873220Medicaid