Provider Demographics
NPI:1588931745
Name:DAVID N GREENBLUM, MD, PA
Entity type:Organization
Organization Name:DAVID N GREENBLUM, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:GREENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-269-7659
Mailing Address - Street 1:805 CENTURY MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2100
Mailing Address - Country:US
Mailing Address - Phone:321-269-7659
Mailing Address - Fax:321-383-2515
Practice Address - Street 1:805 CENTURY MEDICAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2100
Practice Address - Country:US
Practice Address - Phone:321-269-7659
Practice Address - Fax:321-383-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00418572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1467462713Medicare UPIN