Healthcare Provider Details

I. General information

NPI: 1831159870
Provider Name (Legal Business Name): ROBERT GREENBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPRESSWAY
JAMAICA NY
11418
US

IV. Provider business mailing address

89-06 135TH ST 7L
JAMAICA NY
11418
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-7794
  • Fax: 718-206-6145
Mailing address:
  • Phone: 718-206-7820
  • Fax: 718-206-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number143932
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: