Provider Demographics
NPI:1699849364
Name:GREENBERG, ELLIOT M (DPT)
Entity Type:Individual
Prefix:MR
First Name:ELLIOT
Middle Name:M
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518
Mailing Address - Country:US
Mailing Address - Phone:914-763-5941
Mailing Address - Fax:914-763-5332
Practice Address - Street 1:890 ROUTE 35
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518
Practice Address - Country:US
Practice Address - Phone:914-763-5941
Practice Address - Fax:914-763-5332
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0271511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist