Provider Demographics
NPI:1437586807
Name:GREENBERG, MICHAEL (ANP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FRANKLIN AVE
Mailing Address - Street 2:SUITE ML-6
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1886
Mailing Address - Country:US
Mailing Address - Phone:516-663-3511
Mailing Address - Fax:516-663-4780
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:SUITE ML-6
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1886
Practice Address - Country:US
Practice Address - Phone:516-663-3511
Practice Address - Fax:516-663-4780
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306463-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health