Provider Demographics
NPI:1124115662
Name:GREENBERG, SHELDON BURT (MD)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:BURT
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 MAIN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1080
Mailing Address - Country:US
Mailing Address - Phone:203-845-2244
Mailing Address - Fax:203-845-2249
Practice Address - Street 1:761 MAIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1080
Practice Address - Country:US
Practice Address - Phone:203-845-2244
Practice Address - Fax:203-845-2249
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022559207YX0007X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00125598Medicaid
CT240000041Medicare ID - Type Unspecified
CT00125598Medicaid