Provider Demographics
NPI:1639128408
Name:GREENBERG, JARED SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:SCOTT
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5320 W MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8446
Mailing Address - Country:US
Mailing Address - Phone:920-882-8200
Mailing Address - Fax:920-882-8210
Practice Address - Street 1:5320 W MICHAELS DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8446
Practice Address - Country:US
Practice Address - Phone:920-882-8200
Practice Address - Fax:920-882-8210
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301093647208100000X
WI48756208100000X
PAMT188491208100000X
PAMD432290208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation