Healthcare Provider Details

I. General information

NPI: 1235627191
Provider Name (Legal Business Name): MICHAELA ESTHER GREENBAUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 FRANKLIN ST
TENAFLY NJ
07670-2005
US

IV. Provider business mailing address

32 FRANKLIN ST
TENAFLY NJ
07670-2005
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA11156200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: