Provider Demographics
NPI:1972918621
Name:GREENSTEIN, ERWIN
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:GREENSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BISHOPS FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8804
Mailing Address - Country:US
Mailing Address - Phone:781-736-1964
Mailing Address - Fax:
Practice Address - Street 1:80 RIVER ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-8306
Practice Address - Country:US
Practice Address - Phone:781-891-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist