Provider Demographics
NPI:1699304956
Name:GREENBLATT, MATTHEW ERIC (DPM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ERIC
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12983 SOUTHERN BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9207
Mailing Address - Country:US
Mailing Address - Phone:561-203-9285
Mailing Address - Fax:703-776-3718
Practice Address - Street 1:12983 SOUTHERN BLVD STE 206
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9207
Practice Address - Country:US
Practice Address - Phone:561-203-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4572213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery