Provider Demographics
NPI:1568764249
Name:GREENEHOUSE SURGICARE. PC
Entity Type:Organization
Organization Name:GREENEHOUSE SURGICARE. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIANS
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:
Authorized Official - Last Name:CREVECOEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-433-0044
Mailing Address - Street 1:P.O.BOX 30037
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-0037
Mailing Address - Country:US
Mailing Address - Phone:718-433-0044
Mailing Address - Fax:718-433-4644
Practice Address - Street 1:55 GREENE AVE STE LLA
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6432
Practice Address - Country:US
Practice Address - Phone:718-433-0044
Practice Address - Fax:178-433-4644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNICARE ANESTHESIA,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1779531744G0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744G0900XOther Service ProvidersSpecialistGraphics DesignerGroup - Single Specialty