Provider Demographics
NPI:1811909641
Name:GREENBURG, ROBERT SAR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SAR
Last Name:GREENBURG
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 1:4711 BRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3110
Mailing Address - Country:US
Mailing Address - Phone:818-988-3340
Mailing Address - Fax:
Practice Address - Street 1:4711 BRIGGS AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3110
Practice Address - Country:US
Practice Address - Phone:818-988-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22912174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41770Medicare UPIN
CAG22912AMedicare ID - Type UnspecifiedPROVIDER NUMBER