Provider Demographics
NPI:1760166169
Name:GREENBURG, JILLIAN MARGARET (PA-C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARGARET
Last Name:GREENBURG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 NILES CORTLAND RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1055
Mailing Address - Country:US
Mailing Address - Phone:330-306-0395
Mailing Address - Fax:330-856-5887
Practice Address - Street 1:1932 NILES CORTLAND RD NE STE C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-306-0395
Practice Address - Fax:330-856-5887
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064541363A00000X
PAOA006487363A00000X
OH50.008215RX363A00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant