Provider Demographics
NPI:1700430683
Name:GREENFIELD, PAETYN KRISTINE MARY
Entity type:Individual
Prefix:MS
First Name:PAETYN
Middle Name:KRISTINE MARY
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:FORT COVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:12937-2112
Mailing Address - Country:US
Mailing Address - Phone:518-317-0433
Mailing Address - Fax:
Practice Address - Street 1:3 HIGH ST
Practice Address - Street 2:
Practice Address - City:MOIRA
Practice Address - State:NY
Practice Address - Zip Code:12957-2215
Practice Address - Country:US
Practice Address - Phone:518-317-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030685225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist