Provider Demographics
NPI:1851333967
Name:GREENBERG, STANLEY (DO)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 FLAXMILL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-8806
Mailing Address - Country:US
Mailing Address - Phone:260-359-1250
Mailing Address - Fax:
Practice Address - Street 1:1415 FLAXMILL RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-8806
Practice Address - Country:US
Practice Address - Phone:260-359-1250
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000494A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN090430PPMedicare ID - Type Unspecified
INE03699Medicare UPIN