Provider Demographics
NPI:1508836370
Name:GREENSPAN, SHELDON ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:ALAN
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1154
Mailing Address - Country:US
Mailing Address - Phone:516-741-6111
Mailing Address - Fax:516-741-7539
Practice Address - Street 1:637 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1154
Practice Address - Country:US
Practice Address - Phone:516-741-6111
Practice Address - Fax:516-741-7539
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170066207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01020800Medicaid
NY01020800Medicaid
NY96D831Medicare ID - Type Unspecified