Provider Demographics
NPI:1962744789
Name:GREENBAUM, ALIZA T (OTR/L)
Entity type:Individual
Prefix:
First Name:ALIZA
Middle Name:T
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALIZA
Other - Middle Name:T
Other - Last Name:VISHNIAVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 BENNETT AVE APT 6G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3046
Mailing Address - Country:US
Mailing Address - Phone:617-921-7978
Mailing Address - Fax:
Practice Address - Street 1:100 BENNETT AVE APT 6G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3046
Practice Address - Country:US
Practice Address - Phone:617-921-7978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016608225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist