MEDICARE: MR. ANDREW ASHER GREENBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	213E00000X	Podiatrist	1184	CT

General Provider Information

NPI Number	:	1760126536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW ASHER GREENBERG

Provider Business Mailing Address
First Line	:	777 ECHO LAKE RD UNIT F
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-6618
Country	:	US
Telephone Number	:	860-274-1773
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 ECHO LAKE RD UNIT F
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-6618
Country	:	US
Telephone Number	:	860-274-1773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	06/30/2025

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