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General NPI Number Information
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NPI Number | 1376664219
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Entity Type | Organization
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Legal Business Name | GREENRIDGE INC.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12 GREENRIDGE AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10605-1238
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Country | US
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Telephone | 914-428-4700
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Fax | 914-428-6971
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Provider Business Mailing Address
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Address Line | 12 GREENRIDGE AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10605-1238
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Country | US
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Telephone | 914-428-4700
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Fax | 914-428-6971
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Authorized Official
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Title or Position | PLASTIC SURGEON
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Name | DR. MORDCAI BLAU
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Credential | M.D, P.C
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Telephone | 914-427-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 135936-1
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License Number State | NY
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