Provider Demographics
NPI:1770635120
Name:MARK GREENSTADT, M.D., INC.
Entity Type:Organization
Organization Name:MARK GREENSTADT, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-717-3021
Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4109
Mailing Address - Country:US
Mailing Address - Phone:818-717-3021
Mailing Address - Fax:818-717-3028
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-717-3021
Practice Address - Fax:818-717-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty