Healthcare Provider Details

I. General information

NPI: 1528135290
Provider Name (Legal Business Name): NELLEKE GREENDYK D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 RONALD REAGAN BLVD
WARWICK NY
10990-4107
US

IV. Provider business mailing address

13 GLENNON RD
WEST MILFORD NJ
07480-2708
US

V. Phone/Fax

Practice location:
  • Phone: 845-986-9222
  • Fax:
Mailing address:
  • Phone: 973-208-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX004528-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: