Provider Demographics
NPI:1194999383
Name:GWEN S. GREENBERG, DPM
Entity type:Organization
Organization Name:GWEN S. GREENBERG, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-437-3939
Mailing Address - Street 1:1255 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 2900
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6256
Mailing Address - Country:US
Mailing Address - Phone:610-437-3939
Mailing Address - Fax:610-437-7820
Practice Address - Street 1:1255 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 2900
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6256
Practice Address - Country:US
Practice Address - Phone:610-437-3939
Practice Address - Fax:610-437-7820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001792L332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28094Medicare UPIN
1001000001Medicare NSC
GR066196Medicare PIN