Provider Demographics
NPI:1427245125
Name:PAUL S GREENBERG MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:PAUL S GREENBERG MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-596-9401
Mailing Address - Street 1:6531 E MANTOVA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4661
Mailing Address - Country:US
Mailing Address - Phone:562-596-9401
Mailing Address - Fax:562-596-0626
Practice Address - Street 1:6531 E MANTOVA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4661
Practice Address - Country:US
Practice Address - Phone:562-596-9401
Practice Address - Fax:562-596-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35916207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C359160Medicaid
A36105Medicare UPIN
W21973Medicare PIN