Basic Information
| Provider Information | |||||||||
| NPI: | 1164906343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENSTONE | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | ALAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2472 MCCLURES CHAPEL RD | ||||||||
| Address2: | |||||||||
| City: | ROSE HILL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242818710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763467235 | ||||||||
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| Practice Location | |||||||||
| Address1: | 208 HEALTH CARE DR | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON GAP | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242772854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765464566 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2018 | ||||||||
| LastUpdateDate: | 09/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0119002719 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.