Basic Information
| Provider Information | |||||||||
| NPI: | 1326071986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENBERG | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1951 SW 172ND AVE | ||||||||
| Address2: | S. 416 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330295593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544473200 | ||||||||
| FaxNumber: | 9544473205 | ||||||||
| Practice Location | |||||||||
| Address1: | 1951 SW 172ND AVE | ||||||||
| Address2: | S. 416 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330295593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544473200 | ||||||||
| FaxNumber: | 9544473205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 01/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9103506 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.