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General NPI Number Information
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NPI Number | 1811279672
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Entity Type | Organization
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Legal Business Name | PAUL J. GREENBERG, DPM
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 9291 LAUREL GROVE RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2969
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Country | US
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Telephone | 804-730-7089
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Fax | 804-730-8987
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Provider Business Mailing Address
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Address Line | 9291 LAUREL GROVE RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2969
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Country | US
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Telephone | 804-730-7089
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Fax | 804-730-8987
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL JAY GREENBERG
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Credential | DPM
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Telephone | 804-730-7089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0103000793
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License Number State | VA
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