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General NPI Number Information
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NPI Number | 1801811070
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Entity Type | Individual
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Provider Name | JUDYTH ELLEN GREENBAUM M.S.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1111 MONTAUK HWY SUITE 204
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City | WEST ISLIP
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State | NY
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Zip | 11795-4910
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Country | US
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Telephone | 631-376-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 5 LAMB PL
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City | DIX HILLS
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State | NY
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Zip | 11746-6723
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Country | US
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Telephone | 631-667-4633
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Fax |
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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 | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number |
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License Number State |
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