Provider Demographics
NPI:1821073552
Name:GREENBERG, LYON (MD)
Entity Type:Individual
Prefix:
First Name:LYON
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3791
Mailing Address - Country:US
Mailing Address - Phone:518-482-9111
Mailing Address - Fax:518-482-6142
Practice Address - Street 1:6 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3791
Practice Address - Country:US
Practice Address - Phone:518-482-9111
Practice Address - Fax:518-482-6142
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0006394OtherGHI
NY5804723OtherAETNA
NY040426006389OtherFIDELIS
NY10000805OtherCDPHP
NY00478262Medicaid
NY04142OtherMVP
NY259621OtherBLUE CROSS
NY11206OtherWELLCARE
NY11206OtherGHI HMO
NY000406776004OtherBLUE SHIELD
NY040426006389OtherFIDELIS
NY00478262Medicaid