Healthcare Provider Details

I. General information

NPI: 1982284402
Provider Name (Legal Business Name): KENIA GREENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 11/29/2025
Certification Date: 11/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13620 38TH AVE STE 5H
FLUSHING NY
11354-4232
US

IV. Provider business mailing address

13620 38TH AVE STE 5H
FLUSHING NY
11354-4232
US

V. Phone/Fax

Practice location:
  • Phone: 718-661-9554
  • Fax:
Mailing address:
  • Phone: 786-300-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: