Individual provider Active NPI

Elaine Linda Greenberg, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Bronx, NY
National Provider Identifier
1538165808
Registry record updated Feb 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
034851-1 Issued in NY
Practice address
1770 Grand Concourse
Bronx, NY 10457-5524
Phone
(718) 901-8110
Fax
(718) 901-8121
NPI assigned
Jun 22, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 034851-1 NY
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 034851-1 NY Primary

Addresses

Primary practice location

1770 Grand Concourse
Bronx, NY 10457-5524

Mailing address

1770 Grand Concourse
Bronx, NY 10457-5524
Phone (718) 901-8110

Other identifiers 1

IdentifierTypeStateIssuer
02595173MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170814000732 NY Order and Referring Only - DentistPractitioner - Dentist 2567733678

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
034851-1NYMDOrthodontics and Dentofacial Orthopedic Dentist
034851NYMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361750400000",
    "number": "1538165808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104575524",
            "telephone_number": "718-901-8110",
            "fax_number": "718-901-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104575524",
            "telephone_number": "718-901-8110",
            "fax_number": "718-901-8121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENBERG",
        "first_name": "ELAINE",
        "middle_name": "LINDA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-22",
        "last_updated": "2013-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "034851-1",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "034851-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02595173",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.