Healthcare Provider Details

I. General information

NPI: 1154301000
Provider Name (Legal Business Name): RICHARD W GREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BARTOW AVE SUITE 211
BRONX NY
10475-4614
US

IV. Provider business mailing address

200 CENTRAL PARK S SUITE 107
NEW YORK NY
10019-1436
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-1000
  • Fax: 212-765-3210
Mailing address:
  • Phone: 212-262-2500
  • Fax: 212-246-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number79669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: