Provider Demographics
NPI:1790991164
Name:GREENSTEIN, JEFFREY I (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:I
Last Name:GREENSTEIN
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 1:1341 N DELAWARE AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-4300
Mailing Address - Country:US
Mailing Address - Phone:267-597-3830
Mailing Address - Fax:267-597-3831
Practice Address - Street 1:1341 N DELAWARE AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4300
Practice Address - Country:US
Practice Address - Phone:267-597-3830
Practice Address - Fax:267-597-3831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029200E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA058051OtherGROUP MEDICARE NUMBER
PA1699763144OtherGROUP NPI NUMBER
PA102626585 001Medicaid
PA447801QMICMedicare ID - Type Unspecified
PA102626585 001Medicaid