MEDICARE: DR. GREGG GREENBLATT D.P.M.

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	213ES0131X	Foot Surgery Podiatrist	N005193	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	:	1518962679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG GREENBLATT D.P.M.

Provider Business Mailing Address
First Line	:	49 HOLLYWOOD DR
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-3701
Country	:	US
Telephone Number	:	516-644-5731
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 7TH AVE
Second Line	:	# 1404
City	:	NEW YORK
State	:	NY
Zip	:	10018-4603
Country	:	US
Telephone Number	:	212-768-8666
Fax Number	:	212-768-1223

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	06/16/2008

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