Provider Demographics
NPI:1073943460
Name:GREENBERG, NICOLE ELIZABETH (DPT)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MAMARONECK AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1830
Mailing Address - Country:US
Mailing Address - Phone:914-421-8270
Mailing Address - Fax:914-421-8272
Practice Address - Street 1:470 MAMARONECK AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1830
Practice Address - Country:US
Practice Address - Phone:914-421-8270
Practice Address - Fax:914-421-8272
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0371512251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics