Provider Demographics
NPI:1811279672
Name:PAUL J. GREENBERG, DPM
Entity type:Organization
Organization Name:PAUL J. GREENBERG, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-730-7089
Mailing Address - Street 1:9291 LAUREL GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2969
Mailing Address - Country:US
Mailing Address - Phone:804-730-7089
Mailing Address - Fax:804-730-8987
Practice Address - Street 1:9291 LAUREL GROVE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2969
Practice Address - Country:US
Practice Address - Phone:804-730-7089
Practice Address - Fax:804-730-8987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000793332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies