Provider Demographics
NPI:1043218530
Name:GREENBERG, SUSAN NANCY (MS, PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:NANCY
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1251
Mailing Address - Country:US
Mailing Address - Phone:914-738-1777
Mailing Address - Fax:914-738-1772
Practice Address - Street 1:629 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803
Practice Address - Country:US
Practice Address - Phone:914-738-1777
Practice Address - Fax:914-738-1772
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A866744OtherOXFORD
19364POtherHIP
6698344OtherGHI
Q454471OtherBC/BS
A866744OtherOXFORD