Individual provider Active NPI

Susan Nancy Greenberg, MS, PT

  • Physical Therapist
  • Pelham, NY
National Provider Identifier
1043218530
Registry record updated Apr 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4874 Issued in NY
Practice address
629 Fifth Ave
Pelham, NY 10803
Phone
(914) 738-1777
Fax
(914) 738-1772
NPI assigned
Jul 8, 2005
Last updated
Apr 7, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4874 NY Primary

Addresses

Primary practice location

629 Fifth Ave
Pelham, NY 10803

Mailing address

629 Fifth Ave
Pelham, NY 10803-1251
Phone (914) 738-1777

Other identifiers 4

IdentifierTypeStateIssuer
A866744OtherOXFORD
Q454471OtherBC/BS
19364POtherHIP
6698344OtherGHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
4874NYMDPhysical Therapist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207526400000",
    "number": "1043218530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 FIFTH AVE",
            "city": "PELHAM",
            "state": "NY",
            "postal_code": "108031251",
            "telephone_number": "914-738-1777",
            "fax_number": "914-738-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 FIFTH AVE",
            "city": "PELHAM",
            "state": "NY",
            "postal_code": "10803",
            "telephone_number": "914-738-1777",
            "fax_number": "914-738-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENBERG",
        "first_name": "SUSAN",
        "middle_name": "NANCY",
        "name_prefix": "Ms.",
        "credential": "MS, PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-08",
        "last_updated": "2008-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "4874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "A866744",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "Q454471",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "19364P",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "6698344",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pelham, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.