Provider Demographics
NPI:1477533172
Name:GREENBERG, SUSAN NANCY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:NANCY
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1208
Mailing Address - Country:US
Mailing Address - Phone:732-576-8610
Mailing Address - Fax:732-576-8823
Practice Address - Street 1:39 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1208
Practice Address - Country:US
Practice Address - Phone:732-576-8610
Practice Address - Fax:732-576-8823
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04275800207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5274401Medicaid
NJC11873Medicare UPIN
NJ506122QDZMedicare ID - Type Unspecified