Provider Demographics
NPI:1821167552
Name:GREENBERG, LINDA E (MS,RD,CDN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MS,RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 SHORE RD
Mailing Address - Street 2:APT 5 E WEST
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5450
Mailing Address - Country:US
Mailing Address - Phone:718-680-1615
Mailing Address - Fax:718-238-1568
Practice Address - Street 1:2264 HENDRICKSON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5131
Practice Address - Country:US
Practice Address - Phone:718-692-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00002434970 0OtherUNITED HEALTH CARE ID#
NYP418321OtherOXFORD ID #
NY5146740OtherAETNA PROVIDER ID #
NY03P791Medicare ID - Type UnspecifiedPROVIDER ID #