Healthcare Provider Details

I. General information

NPI: 1265503189
Provider Name (Legal Business Name): DANIEL W GREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

PO BOX 29234
NEW YORK NY
10087-9234
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1631
  • Fax: 212-774-2776
Mailing address:
  • Phone: 212-606-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number036159
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number1907421
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number1907421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: