Provider Demographics
NPI:1679879746
Name:BURT M GREENBERG MD PC
Entity type:Organization
Organization Name:BURT M GREENBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIVANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-466-6600
Mailing Address - Street 1:833 NORTHERN BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5315
Mailing Address - Country:US
Mailing Address - Phone:516-466-6600
Mailing Address - Fax:516-466-6603
Practice Address - Street 1:833 NORTHERN BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5315
Practice Address - Country:US
Practice Address - Phone:516-466-6600
Practice Address - Fax:516-466-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169340-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty