Provider Demographics
NPI:1194962472
Name:GREENBERG, MATTHEW E (LAC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:E
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NAPLES LN
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2317
Mailing Address - Country:US
Mailing Address - Phone:516-987-4158
Mailing Address - Fax:
Practice Address - Street 1:10 NAPLES LN
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-2317
Practice Address - Country:US
Practice Address - Phone:516-987-4158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003497171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist