Provider Demographics
NPI:1760126536
Name:GREENBERG, ANDREW ASHER
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ASHER
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 ECHO LAKE RD UNIT F
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-6618
Mailing Address - Country:US
Mailing Address - Phone:860-274-1773
Mailing Address - Fax:
Practice Address - Street 1:777 ECHO LAKE RD UNIT F
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-6618
Practice Address - Country:US
Practice Address - Phone:860-274-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT1184213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program