Individual
DR. JACK M GREENWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 N COUNTRY RD, PORT JEFFERSON, NY 11777-2604
(631) 474-0444
(631) 928-8605
Mailing address
120 N COUNTRY RD, PORT JEFFERSON, NY 11777-2604
(631) 474-0444
(631) 928-8605
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
124686
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00664526
—
NY
Enumeration date
06/16/2005
Last updated
04/02/2008
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