MEDICARE: DR. JONATHAN PHILLIP GREENBERG MBBCH

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	207W00000X	Ophthalmology Physician	MD480594	PA
2	207W00000X	Ophthalmology Physician	25MA11104200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992189500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN PHILLIP GREENBERG MBBCH

Provider Business Mailing Address
First Line	:	420 MOUNTAIN AVE FL 4
Second Line	:
City	:	NEW PROVIDENCE
State	:	NJ
Zip	:	07974-2736
Country	:	US
Telephone Number	:	908-458-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1044 ROUTE 23 STE 208
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-6685
Country	:	US
Telephone Number	:	973-633-9898
Fax Number	:

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

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	11/13/2024

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