Provider Demographics
NPI:1821013566
Name:GREENBERG, WILLIAM CHARLES (APRN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301A W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 106-C
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3409
Mailing Address - Country:US
Mailing Address - Phone:561-391-4669
Mailing Address - Fax:561-391-1815
Practice Address - Street 1:7301A W PALMETTO PARK RD
Practice Address - Street 2:SUITE 106-C
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3409
Practice Address - Country:US
Practice Address - Phone:561-391-4669
Practice Address - Fax:561-391-1815
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNS 9437804364SP0809X
MARN128602364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00056190OtherRAIL ROAD MEDICARE
MANS0444Medicare ID - Type Unspecified
MAP00056190OtherRAIL ROAD MEDICARE
MAP00056190OtherRAIL ROAD MEDICARE