Healthcare Provider Details

I. General information

NPI: 1235111493
Provider Name (Legal Business Name): GARY DAVID GREENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PROSPECT ST SUITE 202
LAKEWOOD NJ
08701-5020
US

IV. Provider business mailing address

35 STONY HILL DR
MORGANVILLE NJ
07751-1176
US

V. Phone/Fax

Practice location:
  • Phone: 732-942-4442
  • Fax:
Mailing address:
  • Phone: 732-851-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number79483
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number208875
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: