Provider Demographics
NPI:1265709893
Name:JOEL G. GREENSPAN, M.D. PC
Entity type:Organization
Organization Name:JOEL G. GREENSPAN, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GREENSPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-738-1659
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-0280
Mailing Address - Country:US
Mailing Address - Phone:800-738-1659
Mailing Address - Fax:704-871-2127
Practice Address - Street 1:838 PELHAMDALE AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-1032
Practice Address - Country:US
Practice Address - Phone:800-738-1659
Practice Address - Fax:704-871-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1380001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY138000-1OtherLICENSE