Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 022359 | NY |
NPI | 1932246717 |
---|---|
Provider Name | Dr. Stanley Greenberg |
First Address | Jamaica, NY 11418-2897 |
Second Address | Jamaica, NY 11418-2897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
628659 | (02) | NY |