MEDICARE: MS. MISHA N 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1699287052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MISHA N GREEN

Provider Business Mailing Address
First Line	:	1516 NORTH AVE
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-2130
Country	:	US
Telephone Number	:	914-310-4706
Fax Number	:

Provider Business Practice Location Address
First Line	:	1232 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-1904
Country	:	US
Telephone Number	:	347-871-9002
Fax Number	:

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

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	10/25/2017

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Directions to “ MS. MISHA N GREEN ” Practice Location

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