MEDICARE: TATIANA LINDSEY GREEN

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	225700000X	Massage Therapist	032495-01	NY

General Provider Information

NPI Number	:	1609457076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA LINDSEY GREEN

Provider Business Mailing Address
First Line	:	2313 DEAN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4301
Country	:	US
Telephone Number	:	347-447-2950
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 DEAN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4301
Country	:	US
Telephone Number	:	347-447-2950
Fax Number	:

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

Provider Enumeration Date	:	04/17/2021
Last Update Date	:	04/17/2021

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Directions to “ TATIANA LINDSEY GREEN ” Practice Location

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