Provider Demographics
NPI:1922750116
Name:GREENBURG, ERAN
Entity Type:Individual
Prefix:
First Name:ERAN
Middle Name:
Last Name:GREENBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3858
Mailing Address - Country:US
Mailing Address - Phone:801-377-0733
Mailing Address - Fax:
Practice Address - Street 1:1618 E PARK AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3858
Practice Address - Country:US
Practice Address - Phone:801-377-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator