Provider Demographics
NPI:1528135290
Name:GREENDYK, NELLEKE (DC)
Entity type:Individual
Prefix:DR
First Name:NELLEKE
Middle Name:
Last Name:GREENDYK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GLENNON RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-2708
Mailing Address - Country:US
Mailing Address - Phone:973-208-9774
Mailing Address - Fax:
Practice Address - Street 1:214 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4107
Practice Address - Country:US
Practice Address - Phone:845-986-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004528-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528135290OtherNPI
NYX27211Medicare UPIN