Provider Demographics
NPI:1871285122
Name:GREENSTEIN, SIMON
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:GREENSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LINWOOD AVE APT 15N
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3153
Mailing Address - Country:US
Mailing Address - Phone:201-681-9116
Mailing Address - Fax:
Practice Address - Street 1:2100 88TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4709
Practice Address - Country:US
Practice Address - Phone:201-758-2895
Practice Address - Fax:201-758-2897
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00181500156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician