Healthcare Provider Details

I. General information

NPI: 1508836370
Provider Name (Legal Business Name): SHELDON ALAN GREENSPAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 WILLIS AVE
WILLISTON PARK NY
11596-1154
US

IV. Provider business mailing address

637 WILLIS AVE
WILLISTON PARK NY
11596-1154
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-6111
  • Fax: 516-741-7539
Mailing address:
  • Phone: 516-741-6111
  • Fax: 516-741-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number170066
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: