MEDICARE: DR. BRUCE ROY GREENBAUM DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	N004557	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	:	1598767600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ROY GREENBAUM DPM

Provider Business Mailing Address
First Line	:	3000 OCEAN PKWY
Second Line	:	APT 2G
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8344
Country	:	US
Telephone Number	:	718-265-2600
Fax Number	:	718-265-0345

Provider Business Practice Location Address
First Line	:	3000 OCEAN PKWY
Second Line	:	APT 2G
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8344
Country	:	US
Telephone Number	:	718-265-2600
Fax Number	:	718-265-0345

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	10/25/2007

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