Healthcare Provider Details

I. General information

NPI: 1447251087
Provider Name (Legal Business Name): GARY GREENSTEIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LINDEN RD
WOODBURY CT
06798-2828
US

IV. Provider business mailing address

3 LINDEN RD
WOODBURY CT
06798-2828
US

V. Phone/Fax

Practice location:
  • Phone: 203-263-4515
  • Fax: 203-263-4515
Mailing address:
  • Phone: 203-263-4515
  • Fax: 203-263-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number450
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: