Healthcare Provider Details

I. General information

NPI: 1750464194
Provider Name (Legal Business Name): SUSAN LYNN GREENE RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST
MOUNT KISCO NY
10549-3417
US

IV. Provider business mailing address

38 JAMES DR
BREWSTER NY
10509-3424
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-1200
  • Fax:
Mailing address:
  • Phone: 917-577-8732
  • Fax: 845-279-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number369628-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: