Active NPI
Gary Scott Greenberg, DMD FAGD
- Dentist
- Syracuse, NY
National Provider Identifier
1740383330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- NYS033643
- Practice address
- 109 South Warren St
Ste 1700
Syracuse, NY 13202 - Phone
- (315) 422-1788
- Fax
- (315) 422-1788
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | NYS033643 | NY | Primary |
Addresses
Primary practice location
109 South Warren St
Ste 1700
Syracuse, NY 13202
Mailing address
109 South Warren St
Ste 1700
Syracuse, NY 13202
Phone (315) 422-1788
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 20, 2016 through Jul 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NYS033643 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323907200000",
"number": "1740383330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 SOUTH WARREN ST",
"address_2": "STE 1700",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13202",
"telephone_number": "315-422-1788",
"fax_number": "315-422-1788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 SOUTH WARREN ST",
"address_2": "STE 1700",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13202",
"telephone_number": "315-422-1788",
"fax_number": "315-422-1788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENBERG",
"first_name": "GARY",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "DMD FAGD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2011-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "NYS033643",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.