Healthcare Provider Details

I. General information

NPI: 1508867425
Provider Name (Legal Business Name): ANDREW J. GREENBERGER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 NORTHFIELD AVE
WEST ORANGE NJ
07052-4723
US

IV. Provider business mailing address

97 NORTHFIELD AVE
WEST ORANGE NJ
07052-4723
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-8300
  • Fax: 973-731-5205
Mailing address:
  • Phone: 973-731-8300
  • Fax: 973-731-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: