Provider Demographics
NPI:1285666503
Name:GREENBERG, ERIC B (DPM)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:B
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 1:3508 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1005
Mailing Address - Country:US
Mailing Address - Phone:610-384-5075
Mailing Address - Fax:610-384-6999
Practice Address - Street 1:3508 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1005
Practice Address - Country:US
Practice Address - Phone:610-384-5075
Practice Address - Fax:610-384-6999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001974L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00508089Medicaid
PA5214940001OtherPTAN
PA00508089Medicaid