Provider Demographics
NPI:1073764809
Name:GREENBERG, WILLIAM JAY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAY
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 E 77TH ST APT LL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2157
Mailing Address - Country:US
Mailing Address - Phone:212-253-7138
Mailing Address - Fax:
Practice Address - Street 1:455 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1060
Practice Address - Country:US
Practice Address - Phone:914-819-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175281-1207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology