Provider Demographics
NPI:1366461428
Name:GREENBERG, ALAN MITCHELL (OPTICAIN)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MITCHELL
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:OPTICAIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6936
Mailing Address - Country:US
Mailing Address - Phone:908-687-3377
Mailing Address - Fax:
Practice Address - Street 1:900 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6936
Practice Address - Country:US
Practice Address - Phone:908-687-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0706450002Medicare PIN