MEDICARE: MR. BURT M GREENBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	169340	NY

General Provider Information

NPI Number	:	1427152677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BURT M GREENBERG MD

Provider Business Mailing Address
First Line	:	833 NORTHERN BLVD STE 270
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5322
Country	:	US
Telephone Number	:	516-466-6600
Fax Number	:	516-466-6603

Provider Business Practice Location Address
First Line	:	833 NORTHERN BLVD STE 270
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5322
Country	:	US
Telephone Number	:	516-466-6600
Fax Number	:	516-466-6603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2006
Last Update Date	:	09/07/2021

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