Provider Demographics
NPI:1164698171
Name:PAUL M. GREENBERG, DPM
Entity Type:Organization
Organization Name:PAUL M. GREENBERG, DPM
Other - Org Name:PAUL M. GREENBERG, DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-874-3578
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:212-874-3578
Practice Address - Fax:212-496-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004559213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01258662Medicaid
U27611Medicare UPIN
NYP53431Medicare PIN