Healthcare Provider Details

I. General information

NPI: 1346354404
Provider Name (Legal Business Name): MARC S GREENSTEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/15/2023
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 W RIDGE RD BUILDING D
ROCHESTER NY
14626-3249
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 668
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-1580
  • Fax: 585-225-2040
Mailing address:
  • Phone: 585-671-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number190045
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number190045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: