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NPI Code Detail

MEDICARE: BRENDA GREEN NP

MEDICARE: BRENDA GREEN NP
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
1363LF0000XFamily Nurse Practitioner344282NY

General Provider Information

NPI Number : 1861014052
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA GREEN NP
Provider Business Mailing Address
First Line : 5075 FIELDSTON RD
Second Line :
City : BRONX
State : NY
Zip : 10471-2909
Country : US
Telephone Number : 347-330-9102
Fax Number :
Provider Business Practice Location Address
First Line : 6301 RIVERDALE AVE
Second Line :
City : BRONX
State : NY
Zip : 10471-1046
Country : US
Telephone Number : 347-330-9102
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2020
Last Update Date : 05/11/2020

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