=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124619010
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT DANIEL GREENWALD LMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2021
-----------------------------------------------------
Last Update Date | 05/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1970 ROUTE 112 STE 6
-----------------------------------------------------
City | CORAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11727-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-796-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 DUPONT ST STE 110
-----------------------------------------------------
City | PLAINVIEW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11803-1606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-796-2400
-----------------------------------------------------
Fax | 516-796-2500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 007525
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 014567
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------