Healthcare Provider Details

I. General information

NPI: 1326071986
Provider Name (Legal Business Name): AMY GREENBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 SW 172ND AVE S. 416
MIRAMAR FL
33029-5593
US

IV. Provider business mailing address

1951 SW 172ND AVE S. 416
MIRAMAR FL
33029-5593
US

V. Phone/Fax

Practice location:
  • Phone: 954-447-3200
  • Fax: 954-447-3205
Mailing address:
  • Phone: 954-447-3200
  • Fax: 954-447-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: