Provider Demographics
NPI:1295704278
Name:GREENBERG, GWEN STEPHANIE (DPM)
Entity type:Individual
Prefix:DR
First Name:GWEN
Middle Name:STEPHANIE
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1405 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2308
Mailing Address - Country:US
Mailing Address - Phone:610-437-3939
Mailing Address - Fax:484-244-2862
Practice Address - Street 1:1255 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 2900
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6256
Practice Address - Country:US
Practice Address - Phone:610-437-3939
Practice Address - Fax:484-244-2862
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001792L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000504203Medicaid
PA000504203Medicaid
PAT28094Medicare UPIN
PA1001000001Medicare NSC