Provider Demographics
NPI:1437136710
Name:GREENBERG, STEPHEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E 72ND ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4028
Mailing Address - Country:US
Mailing Address - Phone:212-288-1575
Mailing Address - Fax:212-288-7616
Practice Address - Street 1:519 E 72ND ST
Practice Address - Street 2:STE. 103
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4028
Practice Address - Country:US
Practice Address - Phone:212-288-1575
Practice Address - Fax:212-288-7616
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186988-12085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG07129Medicare UPIN
NY622321Medicare PIN