Healthcare Provider Details

I. General information

NPI: 1023078334
Provider Name (Legal Business Name): LAWRENCE GREITZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 JONES AVE
CHATHAM NY
12037-1136
US

IV. Provider business mailing address

29 JONES AVE
CHATHAM NY
12037-1136
US

V. Phone/Fax

Practice location:
  • Phone: 518-392-2277
  • Fax: 518-392-7883
Mailing address:
  • Phone: 518-392-2277
  • Fax: 518-392-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number119818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: