Provider Demographics
NPI:1831160720
Name:GREENBERG, JASON P (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HELEN HAYES HOSPITAL
Mailing Address - Street 2:ROUTE 9W
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1195
Mailing Address - Country:US
Mailing Address - Phone:845-786-4459
Mailing Address - Fax:845-786-4890
Practice Address - Street 1:HELEN HAYES HOSPITAL
Practice Address - Street 2:ROUTE 9W
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1195
Practice Address - Country:US
Practice Address - Phone:845-786-4459
Practice Address - Fax:845-786-4890
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00120208100000X
NY2409902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G23334Medicare UPIN
NC2221450AMedicare ID - Type Unspecified