Healthcare Provider Details

I. General information

NPI: 1093715575
Provider Name (Legal Business Name): DARIUS B GREENE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HEMPSTEAD TPKE SUITE 205
BETHPAGE NY
11714-5700
US

IV. Provider business mailing address

4230 HEMPSTEAD TPKE SUITE 205
BETHPAGE NY
11714-5700
US

V. Phone/Fax

Practice location:
  • Phone: 516-735-3030
  • Fax: 516-735-3285
Mailing address:
  • Phone: 516-735-3030
  • Fax: 516-735-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number159223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: