Provider Demographics
NPI:1730457631
Name:A JOSEPH GREENBERG DPM INC PS
Entity Type:Organization
Organization Name:A JOSEPH GREENBERG DPM INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-522-6640
Mailing Address - Street 1:PO BOX 15964
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-0964
Mailing Address - Country:US
Mailing Address - Phone:206-522-6640
Mailing Address - Fax:206-527-0147
Practice Address - Street 1:7301 45TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6103
Practice Address - Country:US
Practice Address - Phone:206-522-6640
Practice Address - Fax:206-527-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP000000439213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1056126Medicaid