Healthcare Provider Details

I. General information

NPI: 1932343209
Provider Name (Legal Business Name): JONATHAN HENRY GREENWALD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FOUCHER ST
NEW ORLEANS LA
70115-3515
US

IV. Provider business mailing address

1401 FOUCHER ST M1005
NEW ORLEANS LA
70115-3515
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-8543
  • Fax:
Mailing address:
  • Phone: 504-897-8543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDO000332
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: