1386623668 NPI number — CARRIE GREENBERG MD

Table of content: CARRIE GREENBERG MD (NPI 1386623668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386623668 NPI number — CARRIE GREENBERG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENBERG
Provider First Name:
CARRIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386623668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 48078
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07101-4878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 OVERLOOK RD
Provider Second Line Business Practice Location Address:
STE 311
Provider Business Practice Location Address City Name:
SUMMIT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07901-3570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-598-1500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  25MA07496100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 067368 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICARE PIN".
  • Identifier: 067368DBF , issued by the state of ( NJ ) . This identifiers is of the category "MEDICARE PIN".
  • Identifier: 9083600 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".