Healthcare Provider Details

I. General information

NPI: 1154398816
Provider Name (Legal Business Name): ANTJE L GREENFIELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CHESTERBROOK BLVD
BERWYN PA
19312-3805
US

IV. Provider business mailing address

1865 ROUTE 70 EAST SUITE 130
CHERRY HILL NJ
08003-2013
US

V. Phone/Fax

Practice location:
  • Phone: 610-576-7500
  • Fax: 610-576-7551
Mailing address:
  • Phone: 856-433-2535
  • Fax: 856-528-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA08024800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD072659L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: