Provider Demographics
NPI:1942570304
Name:DOUG S. GREENSPAN, D.C, P.C.
Entity Type:Organization
Organization Name:DOUG S. GREENSPAN, D.C, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:GREENSPAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-641-8800
Mailing Address - Street 1:105-20 CROSS BAY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1515
Mailing Address - Country:US
Mailing Address - Phone:718-641-8800
Mailing Address - Fax:718-641-1344
Practice Address - Street 1:105-20 CROSS BAY BOULEVARD
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1515
Practice Address - Country:US
Practice Address - Phone:718-641-8800
Practice Address - Fax:718-641-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1033295050OtherNPI # FOR INDIVIDUAL