Greenwood, Jack M

Greenwood, Jack M is an sole proprietor health care provider with primary practice located at 120 N Country Rd , Port Jefferson NY 11777-2604. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology, which is considered as his primary health care specialty. Greenwood, Jack M can be contacted via phone (631) 474-0444.

Contact Information

Primary practice address
120 N Country Rd Port Jefferson NY 11777-2604
Phone: (631) 474-0444
Fax: (631) 928-8605
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology 2084N0402X 124686 New York

Profile Details

NPI number 1851396865
LBN Legal business name Greenwood, Jack M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 16th, 2005
Last updated Apr 2nd, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851396865 NPPES
New York MEDICAID 00664526

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