Provider Demographics
NPI:1306925664
Name:GREENBERG, BETH ILENE (MD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:ILENE
Last Name:GREENBERG
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 1:12 W 18TH ST
Mailing Address - Street 2:APT 9E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4614
Mailing Address - Country:US
Mailing Address - Phone:212-242-3404
Mailing Address - Fax:
Practice Address - Street 1:3 PENN PLZ E # PP-14B
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2258
Practice Address - Country:US
Practice Address - Phone:973-466-7381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07715800302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization