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General NPI Number Information
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NPI Number | 1992189500
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Entity Type | Individual
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Provider Name | JONATHAN PHILLIP GREENBERG MBBCH
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Gender | Male
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1044 ROUTE 23 STE 208
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City | WAYNE
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State | NJ
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Zip | 07470-6685
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Country | US
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Telephone | 973-633-9898
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Fax |
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Provider Business Mailing Address
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Address Line | 420 MOUNTAIN AVE FL 4
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City | NEW PROVIDENCE
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State | NJ
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Zip | 07974-2736
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Country | US
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Telephone | 908-458-8333
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD480594
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA11104200
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License Number State | NJ
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