Provider Demographics
NPI:1730148610
Name:GREENFIELD, FRED D (MR)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:D
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:MR
Other - Prefix:
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Mailing Address - Street 1:14 POWER HORN DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:845-362-0564
Mailing Address - Fax:
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:COLUMBIA UNIVERSITY PEDIATRICS3959
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-304-7250
Practice Address - Fax:212-544-1974
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1705622080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379395Medicaid
NY01379395Medicaid
NY12L421Medicare ID - Type Unspecified