Healthcare Provider Details

I. General information

NPI: 1710978812
Provider Name (Legal Business Name): STEWART GREISMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2005
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 W 57TH ST APT 106
NEW YORK NY
10019-1701
US

IV. Provider business mailing address

457 W 57TH ST APT 106
NEW YORK NY
10019-1701
US

V. Phone/Fax

Practice location:
  • Phone: 212-265-1471
  • Fax:
Mailing address:
  • Phone: 212-265-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number157738
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: