Healthcare Provider Details

I. General information

NPI: 1437586807
Provider Name (Legal Business Name): MICHAEL GREENBERG ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 FRANKLIN AVE SUITE ML-6
GARDEN CITY NY
11530-1886
US

IV. Provider business mailing address

1300 FRANKLIN AVE SUITE ML-6
GARDEN CITY NY
11530-1886
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-3511
  • Fax: 516-663-4780
Mailing address:
  • Phone: 516-663-3511
  • Fax: 516-663-4780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306463-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: