Provider Demographics
NPI:1417907205
Name:GREENSPAN, JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S BAYLES AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3765
Mailing Address - Country:US
Mailing Address - Phone:516-767-7771
Mailing Address - Fax:516-767-7765
Practice Address - Street 1:44 S BAYLES AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3765
Practice Address - Country:US
Practice Address - Phone:516-767-7771
Practice Address - Fax:516-767-7765
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107499207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01158401Medicaid
NYC08297Medicare UPIN
NY31572Medicare ID - Type Unspecified