Provider Demographics
NPI:1215907449
Name:GREINER, SETH (MSPT)
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:
Last Name:GREINER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-4730
Mailing Address - Country:US
Mailing Address - Phone:617-319-6367
Mailing Address - Fax:617-319-6367
Practice Address - Street 1:4 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:EAST QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11942-4730
Practice Address - Country:US
Practice Address - Phone:617-319-6367
Practice Address - Fax:617-319-6367
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027028-1225100000X
NJ40QA01277900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ204691UREOtherMEDICARE
NYA400020721OtherMEDICARE NUMBER
NYA400020721OtherMEDICARE NUMBER
NYA300105406Medicare PIN