Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 22DI02560300 | NJ |
NPI | 1164792453 |
---|---|
Provider Name | Dr. Daniel Seth Greenbaum |
First Address | Fairfield, NJ 07004-1938 |
Second Address | Fairfield, NJ 07004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2012 |
Last Update Date | 21/06/2018 |