Basic Information
| Provider Information | |||||||||
| NPI: | 1649205493 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENBAUM | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 SUSSEX PL | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069052931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462423799 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 SHELBURNE RD | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069023628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304934443 | ||||||||
| FaxNumber: | 3304938677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4301082237 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 44305 | CT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.