Healthcare Provider Details

I. General information

NPI: 1558338756
Provider Name (Legal Business Name): PIETRA DALE GREENBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD SUITE E
BRONX NY
10468-3904
US

IV. Provider business mailing address

130 W KINGSBRIDGE RD SUITE E
BRONX NY
10468-3904
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax: 718-741-4295
Mailing address:
  • Phone: 718-584-9000
  • Fax: 718-741-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number187694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: