Healthcare Provider Details

I. General information

NPI: 1770885824
Provider Name (Legal Business Name): BRUCE L. GREENBERG D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 EAST 48 STREET SUITE 1701
NEW YORK NY
10017
US

IV. Provider business mailing address

18 EAST 48 STREET SUITE 1701
NEW YORK NY
10017
US

V. Phone/Fax

Practice location:
  • Phone: 212-319-9777
  • Fax: 212-319-9799
Mailing address:
  • Phone: 212-319-9777
  • Fax: 212-319-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number040270
License Number StateNY

VIII. Authorized Official

Name: BRUCE L GREENBERG
Title or Position: PRESIDENT/OWNER
Credential: D.D.S.
Phone: 212-319-9777