Healthcare Provider Details

I. General information

NPI: 1801090576
Provider Name (Legal Business Name): TRICIA DANIELLE GREENE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 54TH ST 2N
NEW YORK NY
10022-4707
US

IV. Provider business mailing address

245 E 54TH ST 2N
NEW YORK NY
10022-4707
US

V. Phone/Fax

Practice location:
  • Phone: 212-570-6800
  • Fax: 212-861-7964
Mailing address:
  • Phone: 212-570-6800
  • Fax: 212-861-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number243505-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: