Healthcare Provider Details

I. General information

NPI: 1467524652
Provider Name (Legal Business Name): GREEN, STUART & MARINOW, HARRY & BONFILIO, NICHOLAS & FEIWELL, LAWRENC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 ELM AVE SUITE 100
LONG BEACH CA
90813-3264
US

IV. Provider business mailing address

1040 ELM AVE SUITE 100
LONG BEACH CA
90813-3264
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-4444
  • Fax: 562-436-7350
Mailing address:
  • Phone: 562-591-4444
  • Fax: 562-436-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DUKE AHN
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 562-430-3561