Healthcare Provider Details

I. General information

NPI: 1144208208
Provider Name (Legal Business Name): ROBERT S GREENBAUM OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2006
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 ROUTE 55
LAGRANGEVILLE NY
12540-5045
US

IV. Provider business mailing address

1110 ROUTE 55
LAGRANGEVILLE NY
12540-5045
US

V. Phone/Fax

Practice location:
  • Phone: 845-473-0220
  • Fax: 845-473-0140
Mailing address:
  • Phone: 845-473-0220
  • Fax: 845-473-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT4414
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT S GREENBAUM
Title or Position: OWNER
Credential: OD
Phone: 845-473-0220