Healthcare Provider Details

I. General information

NPI: 1982002069
Provider Name (Legal Business Name): TROY GREENWALD ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 E MILLBROOK RD SUITE 121
RALEIGH NC
27604-1746
US

IV. Provider business mailing address

2231 E MILLBROOK RD SUITE 121
RALEIGH NC
27604-1746
US

V. Phone/Fax

Practice location:
  • Phone: 919-954-9996
  • Fax: 919-954-7511
Mailing address:
  • Phone: 919-954-9996
  • Fax: 919-954-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number751
License Number StateTN

VIII. Authorized Official

Name: TROY GREENWALD
Title or Position: PRESIDENT
Credential: HIS
Phone: 919-956-9996