Healthcare Provider Details

I. General information

NPI: 1871735118
Provider Name (Legal Business Name): LESLIE ROBIN GREENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N HARRISON ST
PRINCETON NJ
08540-3512
US

IV. Provider business mailing address

171 E 84TH ST APT 11F
NEW YORK NY
10028-2000
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-5510
  • Fax:
Mailing address:
  • Phone: 516-395-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08537000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: