Healthcare Provider Details

I. General information

NPI: 1265499594
Provider Name (Legal Business Name): ROMAN GREENSPAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

V. Phone/Fax

Practice location:
  • Phone: 315-774-8200
  • Fax: 877-874-1027
Mailing address:
  • Phone: 845-938-4114
  • Fax: 315-774-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24905
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: