Healthcare Provider Details

I. General information

NPI: 1831491406
Provider Name (Legal Business Name): ISAAC GREENFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 KINGS HWY
BROOKLYN NY
11223-1629
US

IV. Provider business mailing address

25 YESHIVA LN
STATEN ISLAND NY
10309-2831
US

V. Phone/Fax

Practice location:
  • Phone: 718-787-1100
  • Fax: 212-792-6058
Mailing address:
  • Phone: 718-787-1100
  • Fax: 212-792-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: