Provider Demographics
NPI:1265840458
Name:GREENBURG, STANLEY
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:GREENBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HAMPTON VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2127
Mailing Address - Country:US
Mailing Address - Phone:314-481-6005
Mailing Address - Fax:
Practice Address - Street 1:8839 LADUE ROAD
Practice Address - Street 2:
Practice Address - City:LADUE
Practice Address - State:MO
Practice Address - Zip Code:63124-2045
Practice Address - Country:US
Practice Address - Phone:314-721-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013001166237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist