Provider Demographics
NPI:1386684660
Name:GREENBAUM, ARTHUR DAVID (PT)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:DAVID
Last Name:GREENBAUM
Suffix:
Gender:M
Credentials:PT
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 1232
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-0918
Mailing Address - Country:US
Mailing Address - Phone:516-220-3409
Mailing Address - Fax:516-740-5815
Practice Address - Street 1:16302 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2645
Practice Address - Country:US
Practice Address - Phone:718-353-2225
Practice Address - Fax:718-353-3227
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist