Provider Demographics
NPI:1841359098
Name:GREENSPAN, NOAH (DPT)
Entity type:Individual
Prefix:DR
First Name:NOAH
Middle Name:
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6262
Mailing Address - Country:US
Mailing Address - Phone:212-921-0214
Mailing Address - Fax:212-921-0217
Practice Address - Street 1:22 W 38TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6262
Practice Address - Country:US
Practice Address - Phone:212-921-0214
Practice Address - Fax:212-921-0217
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012954225100000X, 2251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02071525Medicaid
NYQ23081Medicare UPIN
NYQ23081Medicare ID - Type Unspecified