Provider Demographics
NPI:1477037760
Name:GREENBAUM, DEVON SHELBY (LAC)
Entity Type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:SHELBY
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 CENTRAL PARK W APT 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4338
Mailing Address - Country:US
Mailing Address - Phone:914-960-8039
Mailing Address - Fax:
Practice Address - Street 1:435 CENTRAL PARK W APT 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4338
Practice Address - Country:US
Practice Address - Phone:201-421-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006381171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist