Provider Demographics
NPI:1376527747
Name:GREENBERG, SUSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HATFIELD LN
Mailing Address - Street 2:STE 3 EYE PHYSICIANS OF ORANGE COUNTY PC
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6752
Mailing Address - Country:US
Mailing Address - Phone:845-294-5128
Mailing Address - Fax:845-294-1479
Practice Address - Street 1:1 HATFIELD LN
Practice Address - Street 2:STE 3 EYE PHYSICIANS OF ORANGE COUNTY PC
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6752
Practice Address - Country:US
Practice Address - Phone:845-294-5128
Practice Address - Fax:845-294-1479
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUT004779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856211Medicaid
C42211Medicare ID - Type Unspecified
NY01856211Medicaid