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General NPI Number Information
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NPI Number | 1104005230
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Entity Type | Organization
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Legal Business Name | DR. MARK GREENBERG
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 275 N MIDDLETOWN RD
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City | PEARL RIVER
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State | NY
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Zip | 10965-1188
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Country | US
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Telephone | 845-735-5757
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Fax |
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Provider Business Mailing Address
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Address Line | 275 N MIDDLETOWN RD
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City | PEARL RIVER
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State | NY
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Zip | 10965-1188
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Country | US
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Telephone | 845-735-5757
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK L. GREENBERG
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Credential |
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Telephone | 845-735-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3359
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License Number State | NY
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