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General NPI Number Information
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NPI Number | 1720210883
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Entity Type | Organization
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Legal Business Name | GREENHOUSE SURGICARE
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 55 GREENE AVE SUITE LLA
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City | BROOKLYN
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State | NY
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Zip | 11238-1026
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Country | US
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Telephone | 718-622-0111
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Fax | 718-636-5140
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Provider Business Mailing Address
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Address Line | 55 GREENE AVE SUITE LLA
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City | BROOKLYN
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State | NY
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Zip | 11238-1026
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Country | US
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Telephone | 718-622-0111
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Fax | 718-636-5140
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Authorized Official
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Title or Position | ANESTHESIOLOGIST/MEDICAL DIRECTOR
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Name | EVANS CREVECOEUR
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Credential | M.D.
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Telephone | 718-622-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 177953
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License Number State | NY
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