MEDICARE: FIVE TOWNS PEDIATRICS

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	207QA0000X	Adolescent Medicine (Family Medicine) Physician
2	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1538247986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE TOWNS PEDIATRICS

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	:	MEDICAL DIRECTOR
Name	:	ABRAHAM I GREEN
Credential	:	MD
Telephone Number	:	516-295-1200

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	06/26/2024

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Directions to “FIVE TOWNS PEDIATRICS ” Practice Location

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