Healthcare Provider Details

I. General information

NPI: 1649291089
Provider Name (Legal Business Name): MARIANNE GREENBERG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD
ABINGTON PA
19001-3720
US

IV. Provider business mailing address

824 CEDAR GLEN RD
ELKINS PARK PA
19027-1607
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-3334
  • Fax:
Mailing address:
  • Phone: 215-886-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberVP004253G
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberVP004253G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: