Healthcare Provider Details

I. General information

NPI: 1316981285
Provider Name (Legal Business Name): ELAINE K GREENWALD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 OLD COUNTRY RD SUITE 302
PLAINVIEW NY
11803
US

IV. Provider business mailing address

5 VAUXHALL CT
MELVILLE NY
11747
US

V. Phone/Fax

Practice location:
  • Phone: 631-491-5050
  • Fax: 631-253-0471
Mailing address:
  • Phone: 631-491-5050
  • Fax: 631-253-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0081901
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: