Basic Information
| Provider Information | |||||||||
| NPI: | 1538587928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENBERG | ||||||||
| FirstName: | YITZCHOK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22700 SHEVINGTON DR | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480342143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159482582 | ||||||||
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| Practice Location | |||||||||
| Address1: | ONE BROOKDALE PLAZA | ||||||||
| Address2: | BROOKDALE HOSPITAL AND MEDICAL CENTER, DEPT OF SURGERY | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182406386 | ||||||||
| FaxNumber: | 7182406738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2014 | ||||||||
| LastUpdateDate: | 04/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208200000X | 4301501866 | MI | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.