Provider Demographics
NPI:1548252935
Name:GREENBERG, ALAN JEFFREY (DPM)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JEFFREY
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24912 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4020
Mailing Address - Country:US
Mailing Address - Phone:516-328-3111
Mailing Address - Fax:516-328-7712
Practice Address - Street 1:115 VILLAGE HILL DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-8335
Practice Address - Country:US
Practice Address - Phone:631-462-3540
Practice Address - Fax:631-462-8256
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2009-06-02
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
NYN3092213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP33603Medicare ID - Type UnspecifiedPROVIDER NUMBER
NYT31811Medicare UPIN