Provider Demographics
NPI:1851780837
Name:GREENBERG, DARA (BA, MS)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2712
Mailing Address - Country:US
Mailing Address - Phone:516-503-8328
Mailing Address - Fax:
Practice Address - Street 1:64 HARMON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2712
Practice Address - Country:US
Practice Address - Phone:516-503-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY843948141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist