Healthcare Provider Details

I. General information

NPI: 1164442802
Provider Name (Legal Business Name): MICHAEL BENJAMIN GREENSPAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ZUCKER HILLSIDE HOSPITAL, KAUFMAN BLDG 75-59 263 ST
GLEN OAKS NY
11004
US

IV. Provider business mailing address

ZUCKER HILLSIDE HOSPITAL- 75-59 263 ST KAUFMAN BLDG RM 211
GLEN OAKS NY
11004
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-8245
  • Fax:
Mailing address:
  • Phone: 718-470-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number044-527
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: