Provider Demographics
NPI:1144362823
Name:STANLEY L. GREENBAUM MD PC
Entity type:Organization
Organization Name:STANLEY L. GREENBAUM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-368-2007
Mailing Address - Street 1:12A N AIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5105
Mailing Address - Country:US
Mailing Address - Phone:845-368-2007
Mailing Address - Fax:845-368-1360
Practice Address - Street 1:12A N AIRMONT RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5105
Practice Address - Country:US
Practice Address - Phone:845-368-2007
Practice Address - Fax:845-368-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100540207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00172385Medicaid
NYB87374Medicare UPIN
NY899561Medicare ID - Type Unspecified