MEDICARE: DR. LYLE EDWARD GREENMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	5335	NY

General Provider Information

NPI Number	:	1255542056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYLE EDWARD GREENMAN PH.D.

Provider Business Mailing Address
First Line	:	2 SYCAMORE LN
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2522
Country	:	US
Telephone Number	:	516-621-0356
Fax Number	:	516-626-3194

Provider Business Practice Location Address
First Line	:	2 SYCAMORE LN
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2522
Country	:	US
Telephone Number	:	516-621-0356
Fax Number	:	516-626-3194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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