Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 255221 | NY |
Y | 2080P0210X | Pediatric Nephrologist | 54561 | CT |
NPI | 1497082648 |
---|---|
Provider Name | Dr. Jason Henry Greenberg |
First Address | New Haven, CT 06515-2218 |
Second Address | New Haven, CT 06515-2218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2009 |
Last Update Date | 18/07/2016 |