1821013566 NPI number — WILLIAM CHARLES GREENBERG APRN

Table of content: WILLIAM CHARLES GREENBERG APRN (NPI 1821013566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821013566 NPI number — WILLIAM CHARLES GREENBERG APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENBERG
Provider First Name:
WILLIAM
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
M

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:
1821013566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301A W PALMETTO PARK RD
Provider Second Line Business Mailing Address:
SUITE 106-C
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33433-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-391-4669
Provider Business Mailing Address Fax Number:
561-391-1815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301A W PALMETTO PARK RD
Provider Second Line Business Practice Location Address:
SUITE 106-C
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33433-3409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-391-4669
Provider Business Practice Location Address Fax Number:
561-391-1815
Provider Enumeration Date:
07/13/2006

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: 364SP0809X , with the licence number:  CNS 9437804 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00056190 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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