Provider Demographics
NPI:1215097886
Name:GREENBLATT, ADRIENNE MASIN (MD)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:MASIN
Last Name:GREENBLATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579A CRANBURY ROAD
Mailing Address - Street 2:UNIVERSITY RADIOLOGY GROUP, PC
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3360
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-390-1856
Practice Address - Street 1:699 TEANECK ROAD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4244
Practice Address - Country:US
Practice Address - Phone:201-836-2500
Practice Address - Fax:201-836-7921
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA049330002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0014095Medicaid
E13352Medicare UPIN
NJ0014095Medicaid