Healthcare Provider Details

I. General information

NPI: 1942249461
Provider Name (Legal Business Name): JEFFREY BURT GREENBARG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 FRANKLIN DR NE
PALM BAY FL
32905-4022
US

IV. Provider business mailing address

2123 FRANKLIN DR NE
PALM BAY FL
32905-4022
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-1614
  • Fax: 321-722-3590
Mailing address:
  • Phone: 321-724-1614
  • Fax: 321-722-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME88035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: