Provider Demographics
NPI:1295874279
Name:GREENFIELD, JODY SCOTT (DO)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:SCOTT
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 N CONGRESS AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8678
Mailing Address - Country:US
Mailing Address - Phone:561-413-2869
Mailing Address - Fax:
Practice Address - Street 1:1880 N CONGRESS AVE STE 320
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8678
Practice Address - Country:US
Practice Address - Phone:561-413-2869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174885207R00000X
FLOS10555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001L51Medicare ID - Type Unspecified
F10524Medicare UPIN