Healthcare Provider Details

I. General information

NPI: 1134123110
Provider Name (Legal Business Name): PAUL MICHAEL GREENBERG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 79TH ST
NEW YORK NY
10024-6474
US

IV. Provider business mailing address

101 W 79TH ST
NEW YORK NY
10024-6474
US

V. Phone/Fax

Practice location:
  • Phone: 212-874-3576
  • Fax: 212-496-6601
Mailing address:
  • Phone: 212-874-3578
  • Fax: 212-496-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004559
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: