MEDICARE: STEPHEN ROBERT GREENBERG M.D.

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	156FX1100X	Ophthalmic Technician/Technologist	106798	NY
2	207W00000X	Ophthalmology Physician	106798	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699878587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN ROBERT GREENBERG M.D.

Provider Business Mailing Address
First Line	:	260 E MIDDLE COUNTRY RD
Second Line	:	SUITE 201
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2982
Country	:	US
Telephone Number	:	631-265-8780
Fax Number	:	631-265-8521

Provider Business Practice Location Address
First Line	:	233 UNION AVENUE
Second Line	:	SUITE 104/105
City	:	HOLBROOK
State	:	NY
Zip	:	11741-1820
Country	:	US
Telephone Number	:	631-285-7311
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	02/09/2015

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