MEDICARE: KEIRON GREAVES, MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1275760175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEIRON GREAVES, MD PC

Provider Business Mailing Address
First Line	:	PO BOX 24230
Second Line	:	SUITE 203
City	:	NEWARK
State	:	NJ
Zip	:	07101
Country	:	US
Telephone Number	:	732-918-8312
Fax Number	:	914-591-8362

Provider Business Practice Location Address
First Line	:	317 ROUTE 34 STE 323
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-2446
Country	:	US
Telephone Number	:	732-918-8312
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	KEIRON W GREAVES
Credential	:	MD
Telephone Number	:	732-918-8312

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	03/11/2010

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Directions to “KEIRON GREAVES, MD PC ” Practice Location

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