Healthcare Provider Details

I. General information

NPI: 1851260822
Provider Name (Legal Business Name): GREEN CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 77TH ST
ELMHURST NY
11373-1996
US

IV. Provider business mailing address

4112 77TH ST
ELMHURST NY
11373-1996
US

V. Phone/Fax

Practice location:
  • Phone: 718-873-6893
  • Fax:
Mailing address:
  • Phone: 718-873-6893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. NAWSHIN JAMIL
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 718-873-6893