Provider Demographics
NPI:1265137012
Name:DEVON GREENBAUM ACUPUNCTURE
Entity type:Organization
Organization Name:DEVON GREENBAUM ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:914-960-8039
Mailing Address - Street 1:435 CENTRAL PARK W APT 2M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4342
Mailing Address - Country:US
Mailing Address - Phone:914-960-8039
Mailing Address - Fax:
Practice Address - Street 1:353 LEXINGTON AVE FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0941
Practice Address - Country:US
Practice Address - Phone:914-960-8039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1477037760OtherNPPES