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General NPI Number Information
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NPI Number | 1144208208
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Entity Type | Organization
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Legal Business Name | ROBERT S GREENBAUM OD PLLC
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Dates
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Enumeration Date | 01/08/2006
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 1110 ROUTE 55
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City | LAGRANGEVILLE
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State | NY
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Zip | 12540-5045
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Country | US
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Telephone | 845-473-0220
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Fax | 845-473-0140
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Provider Business Mailing Address
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Address Line | 1110 ROUTE 55
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City | LAGRANGEVILLE
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State | NY
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Zip | 12540-5045
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Country | US
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Telephone | 845-473-0220
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Fax | 845-473-0140
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT S GREENBAUM
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Credential | OD
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Telephone | 845-473-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | VUT4414
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License Number State | NY
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