1871533422 NPI number — DR. MICHAEL A GREENBERG

Table of content: DR. MICHAEL A GREENBERG (NPI 1871533422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871533422 NPI number — DR. MICHAEL A GREENBERG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENBERG
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREENBERG
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871533422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56 NEWTOWN RICHBORO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18954-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-322-4139
Provider Business Mailing Address Fax Number:
215-396-8550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 NEWTOWN RICHBORO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18954-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-322-4139
Provider Business Practice Location Address Fax Number:
215-396-8550
Provider Enumeration Date:
06/08/2006

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: 213E00000X , with the licence number:  SC001508L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0050137301 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0023120001 . This is a "KEYSTONE HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1146565002 . This is a "CIGNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PO38460 . This is a "CHAMPUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: GR108040 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0501373 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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