Healthcare Provider Details

I. General information

NPI: 1851494009
Provider Name (Legal Business Name): GREENWALD & MATANI PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 W 23RD ST
NEW YORK NY
10011-2320
US

IV. Provider business mailing address

241 W 23RD ST
NEW YORK NY
10011-2320
US

V. Phone/Fax

Practice location:
  • Phone: 212-691-2112
  • Fax: 212-691-2115
Mailing address:
  • Phone: 212-691-2112
  • Fax: 212-691-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30921
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number49025
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number49379
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number46855
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number052312
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number029075
License Number StateNY

VIII. Authorized Official

Name: DR. GARY GREENWALD
Title or Position: DENTIST
Credential: DMD
Phone: 212-691-2112