Healthcare Provider Details

I. General information

NPI: 1649421967
Provider Name (Legal Business Name): ANNIE GREENBERG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 HACKENSACK AVE 2ND FLOOR
HACKENSACK NJ
07601-6319
US

IV. Provider business mailing address

433 HACKENSACK AVE 2ND FLOOR
HACKENSACK NJ
07601-6319
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-5930
  • Fax:
Mailing address:
  • Phone: 201-880-5930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA01293300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: