Provider Demographics
NPI:1669520334
Name:GREENBERG, MIRIAM CELIA (MD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:CELIA
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 170TH STREET
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3306
Mailing Address - Country:US
Mailing Address - Phone:718-461-9788
Mailing Address - Fax:718-461-9788
Practice Address - Street 1:1408 OCEAN AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:718-677-7600
Practice Address - Fax:718-677-3265
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01695812Medicaid
G23402Medicare UPIN
NY01695812Medicaid