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General NPI Number Information
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NPI Number | 1578621082
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Entity Type | Individual
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Provider Name | MR. KEITH GREIM
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9749 WOODHAVEN BLVD
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City | OZONE PARK
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State | NY
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Zip | 11416-2312
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Country | US
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Telephone | 718-845-8557
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Fax |
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Provider Business Mailing Address
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Address Line | 86 WOOD LN
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City | VALLEY STREAM
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State | NY
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Zip | 11581-2607
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Country | US
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Telephone | 917-302-1504
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Fax | 516-791-5559
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R059202
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License Number State | NY
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