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General NPI Number Information
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NPI Number | 1831362698
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Entity Type | Organization
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Legal Business Name | GREENRIDGE UROLOGY P.C.
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 12 GREENRIDGE AVE SUITE 401
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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 | 914-948-3128
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Fax | 914-948-6809
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Provider Business Mailing Address
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Address Line | 12 GREENRIDGE AVE SUITE 401
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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 | 914-948-3128
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Fax | 914-948-6809
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MATTHEW LAURENCE LEMER
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Credential | M.D.
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Telephone | 914-948-3128
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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 | 205415
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License Number State | NY
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