MEDICARE: BRIAN GREENWALD M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	25MA07073000	NJ
2	225400000X	Rehabilitation Practitioner	229268-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518935089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN GREENWALD M.D.

Provider Business Mailing Address
First Line	:	65 JAMES ST
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3938
Country	:	US
Telephone Number	:	732-321-7000
Fax Number	:	732-321-7330

Provider Business Practice Location Address
First Line	:	80 JAMES ST
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3938
Country	:	US
Telephone Number	:	732-321-7000
Fax Number	:	732-321-7330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	02/03/2016

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