Provider Demographics
NPI:1124619010
Name:GREENWALD, ROBERT DANIEL (LMT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DUPONT ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1606
Mailing Address - Country:US
Mailing Address - Phone:516-796-2400
Mailing Address - Fax:516-796-2500
Practice Address - Street 1:1970 ROUTE 112 STE 6
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2300
Practice Address - Country:US
Practice Address - Phone:516-796-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007525171100000X
NY014567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014567OtherMASSAGE THERAPY
NY007525OtherACUPUNCTURE