Provider Demographics
NPI:1104083112
Name:GREENBERG, MARTIN
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
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 1:1 HANSON PL
Mailing Address - Street 2:SUITE 709
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11243-2907
Mailing Address - Country:US
Mailing Address - Phone:718-638-3388
Mailing Address - Fax:718-638-2205
Practice Address - Street 1:ONE HANSON PLACE
Practice Address - Street 2:SUITE 709
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11243-2907
Practice Address - Country:US
Practice Address - Phone:718-638-3388
Practice Address - Fax:718-638-2205
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27537122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist