Provider Demographics
NPI:1518285063
Name:LAWRENCE B GREENBERG MD PC
Entity Type:Organization
Organization Name:LAWRENCE B GREENBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-617-6903
Mailing Address - Street 1:330 MOTOR PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5104
Mailing Address - Country:US
Mailing Address - Phone:631-617-6903
Mailing Address - Fax:631-617-6902
Practice Address - Street 1:330 MOTOR PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5104
Practice Address - Country:US
Practice Address - Phone:631-617-6903
Practice Address - Fax:631-617-6902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY154567-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A64128Medicare UPIN