Provider Demographics
NPI:1790867786
Name:GREENBERG, STEVEN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DAVID
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-873-1244
Practice Address - Street 1:602 IVY ST FL 2
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1646
Practice Address - Country:US
Practice Address - Phone:607-735-4633
Practice Address - Fax:607-735-4628
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY169298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01086557Medicaid
NY01086557Medicaid
NY55711PMedicare ID - Type UnspecifiedINDIVIDUAL #
NY01086557Medicaid