Provider Demographics
NPI:1518962679
Name:GREENBLATT, GREGG (DPM)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3701
Mailing Address - Country:US
Mailing Address - Phone:516-644-5731
Mailing Address - Fax:
Practice Address - Street 1:512 7TH AVE
Practice Address - Street 2:# 1404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4603
Practice Address - Country:US
Practice Address - Phone:212-768-8666
Practice Address - Fax:212-768-1223
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005193213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01715140Medicaid
NYU59563Medicare UPIN
NY01715140Medicaid