Provider Demographics
NPI:1386687796
Name:GREENBERG, JEFFREY CRAIG (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CRAIG
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4892
Mailing Address - Country:US
Mailing Address - Phone:973-533-9049
Mailing Address - Fax:973-994-4737
Practice Address - Street 1:340 E NORTHFIELD RD
Practice Address - Street 2:SUITE 1E
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4892
Practice Address - Country:US
Practice Address - Phone:973-533-9049
Practice Address - Fax:973-994-4737
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI01913103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGR686232Medicare ID - Type Unspecified