Provider Demographics
NPI:1306955927
Name:GREENBERG, PAUL NATHAN (DPM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:NATHAN
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 EAST 65 STREET
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6756
Mailing Address - Country:US
Mailing Address - Phone:212-794-0089
Mailing Address - Fax:212-650-0047
Practice Address - Street 1:310 EAST 65 STREET
Practice Address - Street 2:SUITE 2E
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10065-6756
Practice Address - Country:US
Practice Address - Phone:212-794-0089
Practice Address - Fax:212-650-0047
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002414213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P024142OtherWORKER COMP
P024142OtherWORKER COMP
P024142OtherWORKER COMP
T50789Medicare UPIN