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General NPI Number Information
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NPI Number | 1215008339
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Entity Type | Individual
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Provider Name | KEITH H GREENBERG D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/11/2006
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 200 W 54TH ST SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10019-5504
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Country | US
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Telephone | 212-664-0030
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Fax | 212-664-8506
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Provider Business Mailing Address
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Address Line | 261 W BROADWAY
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City | LONG BEACH
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State | NY
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Zip | 11561-3938
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Country | US
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Telephone | 516-432-0768
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 222711
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License Number State | NY
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