Healthcare Provider Details

I. General information

NPI: 1164552436
Provider Name (Legal Business Name): TIRZA GREER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2532 GRAND CONCOURSE DEPARTMENT OF PEDIATRICS 2ND FLOOR
BRONX NY
10458-4902
US

IV. Provider business mailing address

2532 GRAND CONCOURSE DEPARTMENT OF PEDIATRICS 2ND FLOOR
BRONX NY
10458-4902
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-1500
  • Fax: 718-960-1500
Mailing address:
  • Phone: 718-960-1500
  • Fax: 718-960-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number246022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: