Provider Demographics
NPI:1386839082
Name:GREENBERG, MARVIN ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:ELLIOTT
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13680 NW 5TH ST
Mailing Address - Street 2:STE 240
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6270
Mailing Address - Country:US
Mailing Address - Phone:954-318-7388
Mailing Address - Fax:954-318-7350
Practice Address - Street 1:7421 N. UNIVERSITY DR.
Practice Address - Street 2:STE. 109
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-726-2080
Practice Address - Fax:954-726-2105
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36221207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL491611OtherUNITED HEALTHCARE
FL065703400Medicaid
FL4348813OtherAETNA
NY0034880OtherGROUP HEALTH INSURANCE
FL79535OtherBLUE SHIELD OF FLORIDA
FL4348813OtherAETNA
FL491611OtherUNITED HEALTHCARE
FLD58834Medicare UPIN