Healthcare Provider Details

I. General information

NPI: 1295390268
Provider Name (Legal Business Name): GREENBERG FOOT AND ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 MIAMISBURG CENTERVILLE RD STE 200
DAYTON OH
45459-3858
US

IV. Provider business mailing address

1989 MIAMISBURG CENTERVILLE RD STE 200
DAYTON OH
45459-3858
US

V. Phone/Fax

Practice location:
  • Phone: 937-938-6444
  • Fax: 937-641-8310
Mailing address:
  • Phone: 937-938-6444
  • Fax: 937-834-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MARC S GREENBERG
Title or Position: OWNER
Credential: DPM
Phone: 937-938-6444