Provider Demographics
NPI:1669743381
Name:DAVID GREUNER M.D., P.C.
Entity type:Organization
Organization Name:DAVID GREUNER M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREUNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-878-4642
Mailing Address - Street 1:730 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2213
Mailing Address - Country:US
Mailing Address - Phone:631-878-4642
Mailing Address - Fax:631-878-4280
Practice Address - Street 1:800 2ND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4709
Practice Address - Country:US
Practice Address - Phone:631-878-4642
Practice Address - Fax:631-878-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08845600208600000X
NY247175208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty