Provider Demographics
NPI:1427152677
Name:GREENBERG, BURT M (MD)
Entity type:Individual
Prefix:MR
First Name:BURT
Middle Name:M
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 NORTHERN BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5322
Mailing Address - Country:US
Mailing Address - Phone:516-466-6600
Mailing Address - Fax:516-466-6603
Practice Address - Street 1:833 NORTHERN BLVD STE 270
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5322
Practice Address - Country:US
Practice Address - Phone:516-466-6600
Practice Address - Fax:516-466-6603
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-09
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1693402086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A60311Medicare UPIN
07E822Medicare ID - Type Unspecified