Provider Demographics
NPI:1134123110
Name:GREENBERG, PAUL MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6474
Mailing Address - Country:US
Mailing Address - Phone:212-874-3578
Mailing Address - Fax:212-496-6601
Practice Address - Street 1:101 W 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6474
Practice Address - Country:US
Practice Address - Phone:212-874-3576
Practice Address - Fax:212-496-6601
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004559213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01258662Medicaid
NY6205230001Medicare NSC
U27611Medicare UPIN
NYP5343-1Medicare PIN