Healthcare Provider Details

I. General information

NPI: 1821164278
Provider Name (Legal Business Name): ROSALIE GREENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 OVERLOOK ROAD SUITE 406
SUMMIT NJ
07901
US

IV. Provider business mailing address

33 OVERLOOK ROAD SUITE 406
SUMMIT NJ
07901
US

V. Phone/Fax

Practice location:
  • Phone: 908-598-0200
  • Fax: 908-598-0924
Mailing address:
  • Phone: 908-598-0200
  • Fax: 908-598-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA04073900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: