Healthcare Provider Details

I. General information

NPI: 1174697171
Provider Name (Legal Business Name): WALTER BARRY GREENFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 NO BROADWAY LL 10
YONKERS NY
10701
US

IV. Provider business mailing address

984 NO BROADWAY LL 10
YONKERS NY
10701
US

V. Phone/Fax

Practice location:
  • Phone: 914-965-3670
  • Fax: 914-965-7857
Mailing address:
  • Phone: 914-965-3670
  • Fax: 914-965-7857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number169756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: