NPIMap

Organization Active NPI

Robert S Greenbaum OD PLLC

  • Optometrist
  • Lagrangeville, NY
National Provider Identifier
1144208208
Registry record updated Nov 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
VUT4414 Issued in NY
Legal business name
ROBERT S GREENBAUM OD PLLC
Practice address
1110 Route 55
Lagrangeville, NY 12540-5045
Phone
(845) 473-0220
Fax
(845) 473-0140
NPI assigned
Jan 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert S Greenbaum, ODNPI 1750387973
Title
Owner
Phone
(845) 473-0220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X VUT4414 NY Primary

Addresses

Primary practice location

1110 Route 55
Lagrangeville, NY 12540-5045

Mailing address

1110 Route 55
Lagrangeville, NY 12540-5045
Phone (845) 473-0220

Other identifiers 7

IdentifierTypeStateIssuer
P2790040OtherNYOXFORD
C2T801OtherNYBXBS
325OtherNYDAVIS
U794OtherNYCDPHP
2144998MedicaidNY
597014OtherNYMVP
NY4414OtherNYEYE MED

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081212000188 NY Part B Supplier - Clinic/Group Practice 6709891625 Receives reassigned benefits from 1 practitioner
Practice locations: Lagrangeville, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1144208208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 ROUTE 55",
            "city": "LAGRANGEVILLE",
            "state": "NY",
            "postal_code": "125405045",
            "telephone_number": "845-473-0220",
            "fax_number": "845-473-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 ROUTE 55",
            "city": "LAGRANGEVILLE",
            "state": "NY",
            "postal_code": "125405045",
            "telephone_number": "845-473-0220",
            "fax_number": "845-473-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT S GREENBAUM OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-08",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "GREENBAUM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-473-0220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT4414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2790040",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BXBS",
            "identifier": "C2T801",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS",
            "identifier": "325",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "U794",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2144998",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "597014",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYE MED",
            "identifier": "NY4414",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrangeville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.