Provider Demographics
NPI:1902075732
Name:ERIC B GREENBERG DPM
Entity Type:Organization
Organization Name:ERIC B GREENBERG DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-384-5075
Mailing Address - Street 1:3508 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1005
Mailing Address - Country:US
Mailing Address - Phone:610-384-5075
Mailing Address - Fax:610-384-6999
Practice Address - Street 1:3508 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1005
Practice Address - Country:US
Practice Address - Phone:610-384-5075
Practice Address - Fax:610-384-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001974L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00508089Medicaid
PA5214940001Medicare NSC
PA016917Medicare Oscar/Certification