Healthcare Provider Details

I. General information

NPI: 1922243021
Provider Name (Legal Business Name): GRETA SALZBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 SOUTHWOODS DR
MONTICELLO NY
12701-7231
US

IV. Provider business mailing address

504 SOUTHWOODS DR
MONTICELLO NY
12701-7231
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-6037
  • Fax: 845-794-4429
Mailing address:
  • Phone: 845-794-6037
  • Fax: 845-794-4429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number039696-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: