Healthcare Provider Details

I. General information

NPI: 1285329581
Provider Name (Legal Business Name): ALEXANDRA R GREENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 168TH ST
NEW YORK NY
10032-3725
US

IV. Provider business mailing address

523 W 148TH ST APT 1
NEW YORK NY
10031-3701
US

V. Phone/Fax

Practice location:
  • Phone: 212-544-1880
  • Fax: 212-544-1870
Mailing address:
  • Phone: 917-733-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number340945-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: