Healthcare Provider Details

I. General information

NPI: 1033141932
Provider Name (Legal Business Name): GREENVILLE MEDICAL ASSOCIATE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 COUNTY ROUTE 26A
GREENVILLE NY
12083-3921
US

IV. Provider business mailing address

PO BOX 98
GREENVILLE NY
12083-0098
US

V. Phone/Fax

Practice location:
  • Phone: 518-966-4433
  • Fax: 518-966-4728
Mailing address:
  • Phone: 518-966-4433
  • Fax: 518-966-4728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number227740
License Number StateNY

VIII. Authorized Official

Name: DR. WALTER W. HUBICKI II
Title or Position: PRESIDENT
Credential: MD
Phone: 518-966-4433