Provider Demographics
NPI:1902187065
Name:GREENIDGE, NINI ASHEKI
Entity Type:Individual
Prefix:MS
First Name:NINI
Middle Name:ASHEKI
Last Name:GREENIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13708 PASEO SERENO DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-8430
Mailing Address - Country:US
Mailing Address - Phone:201-737-2031
Mailing Address - Fax:
Practice Address - Street 1:13708 PASEO SERENO DR
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-8430
Practice Address - Country:US
Practice Address - Phone:201-737-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX222Q0000XOther22 RESPIRATORY DEVELOPMENT RESPIRATORY SERVICES PROVIDER