Provider Demographics
NPI:1750346060
Name:GREENKY, BRETT B (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:B
Last Name:GREENKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5719 WIDEWATERS PKWY
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1880
Mailing Address - Country:US
Mailing Address - Phone:315-251-3100
Mailing Address - Fax:315-449-9923
Practice Address - Street 1:4115 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6636
Practice Address - Country:US
Practice Address - Phone:315-329-7600
Practice Address - Fax:315-329-7608
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY170239207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01360021Medicaid