Provider Demographics
NPI:1538240114
Name:GREENBERG, ERIC TODD (PT, DPT, SCS, CSCS)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:TODD
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:PT, DPT, SCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WOODROW PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7337
Mailing Address - Country:US
Mailing Address - Phone:516-384-0011
Mailing Address - Fax:
Practice Address - Street 1:611 OLD WILLETS PATH
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4105
Practice Address - Country:US
Practice Address - Phone:631-232-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027624-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027624-1OtherLICENSE NUMBER