Provider Demographics
NPI:1467572289
Name:JOEL D GREENBERG MD PA
Entity Type:Organization
Organization Name:JOEL D GREENBERG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-268-4767
Mailing Address - Street 1:4401 S HOPKINS AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6679
Mailing Address - Country:US
Mailing Address - Phone:321-268-4767
Mailing Address - Fax:321-267-8765
Practice Address - Street 1:4401 S HOPKINS AVE
Practice Address - Street 2:STE 103
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6679
Practice Address - Country:US
Practice Address - Phone:321-268-4767
Practice Address - Fax:321-267-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X
FLME49333207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045628400Medicaid
FL045628400Medicaid
FL24943Medicare PIN