Provider Demographics
NPI:1336248970
Name:GREENSPUN, DAVID TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TODD
Last Name:GREENSPUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 BROADWAY
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2002
Mailing Address - Country:US
Mailing Address - Phone:212-744-1200
Mailing Address - Fax:212-265-1776
Practice Address - Street 1:2 GREENWICH OFFICE PARK STE 210
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5155
Practice Address - Country:US
Practice Address - Phone:032-863-0003
Practice Address - Fax:212-265-1776
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222157208200000X
CT045603208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY152 4F1Medicare ID - Type Unspecified
NYI03868Medicare UPIN