Basic Information
| Provider Information | |||||||||
| NPI: | 1568764249 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GREENEHOUSE SURGICARE. PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O.BOX 30037 | ||||||||
| Address2: | |||||||||
| City: | ELMONT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110030037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184330044 | ||||||||
| FaxNumber: | 7184334644 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 GREENE AVE STE LLA | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112386432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184330044 | ||||||||
| FaxNumber: | 1784334644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2010 | ||||||||
| LastUpdateDate: | 12/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | CREVECOEUR | ||||||||
| AuthorizedOfficialFirstName: | EVANS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PHYSICIANS | ||||||||
| AuthorizedOfficialTelephone: | 7184330044 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OMNICARE ANESTHESIA,PC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1744G0900X | 177953 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | Graphics Designer |
No ID Information.