Healthcare Provider Details

I. General information

NPI: 1992744692
Provider Name (Legal Business Name): THERESA GREENFIELD D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 COVE RD
OYSTER BAY NY
11771-3410
US

IV. Provider business mailing address

175 COVE RD
OYSTER BAY NY
11771-3410
US

V. Phone/Fax

Practice location:
  • Phone: 516-922-1519
  • Fax: 516-922-1519
Mailing address:
  • Phone: 516-922-1519
  • Fax: 516-922-1519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007620-0
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: