MEDICARE: DR. JUDITH GREEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	272060	NY

General Provider Information

NPI Number	:	1285921478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH GREEN MD

Provider Business Mailing Address
First Line	:	145 FRANKLIN PL
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1218
Country	:	US
Telephone Number	:	516-295-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 FRANKLIN PL
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1218
Country	:	US
Telephone Number	:	516-295-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	06/06/2014

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Directions to “ DR. JUDITH GREEN MD” Practice Location

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