Provider Demographics
NPI:1831151893
Name:GREENBERG, ALAN JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAY
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SUNSET STRIP
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1345
Mailing Address - Country:US
Mailing Address - Phone:973-584-4600
Mailing Address - Fax:973-584-9359
Practice Address - Street 1:66 SUNSET STRIP
Practice Address - Street 2:SUITE 306
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1345
Practice Address - Country:US
Practice Address - Phone:973-584-4600
Practice Address - Fax:973-584-9359
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD00098200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1913107Medicaid
NJ1913107Medicaid
NJ111930C7GMedicare ID - Type Unspecified