Provider Demographics
NPI:1629053335
Name:GREENBLATT, STEVEN MARK (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:GREENBLATT
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 1:420 E 72ND ST
Mailing Address - Street 2:APT. 6 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4650
Mailing Address - Country:US
Mailing Address - Phone:212-879-3043
Mailing Address - Fax:212-879-3043
Practice Address - Street 1:420 E 72ND ST
Practice Address - Street 2:APT. 6 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4650
Practice Address - Country:US
Practice Address - Phone:212-879-3043
Practice Address - Fax:212-879-3043
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005903-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist