Provider Demographics
NPI:1144208208
Name:ROBERT S GREENBAUM OD PLLC
Entity type:Organization
Organization Name:ROBERT S GREENBAUM OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-473-0220
Mailing Address - Street 1:1110 ROUTE 55
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5045
Mailing Address - Country:US
Mailing Address - Phone:845-473-0220
Mailing Address - Fax:845-473-0140
Practice Address - Street 1:1110 ROUTE 55
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5045
Practice Address - Country:US
Practice Address - Phone:845-473-0220
Practice Address - Fax:845-473-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-08
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT4414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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NY2144998Medicaid
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NYNY4414OtherEYE MED
NYP2790040OtherOXFORD
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NY=========OtherPOMCO
NY=========OtherAETNA
NY597014OtherMVP