MEDICARE: JAMIE GREENBAUM

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	235Z00000X	Speech-Language Pathologist	020350-1	NY

General Provider Information

NPI Number	:	1740586866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE GREENBAUM

Provider Business Mailing Address
First Line	:	184 KENT AVE
Second Line	:	APT D309
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	184 KENT AVE
Second Line	:	APT D309
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3118
Country	:	US
Telephone Number	:	301-461-1733
Fax Number	:

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

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	02/07/2011

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Directions to “ JAMIE GREENBAUM ” Practice Location

Language	Start Address	Practice Location

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