Healthcare Provider Details

I. General information

NPI: 1164436770
Provider Name (Legal Business Name): STEPHEN H GREEN MD FACS & STANLEY K KLAUSNER MD FACS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 SILLS RD BUILDING 2 SUITE A
PATCHOGUE NY
11772
US

IV. Provider business mailing address

285 SILLS RD BUILDING 2 SUITE A
PATCHOGUE NY
11772
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-8846
  • Fax: 631-475-8860
Mailing address:
  • Phone: 631-475-8846
  • Fax: 631-475-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number101835
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number099292
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier101835
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENSE DR K
# 2
Identifier099292
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENSE DR G
# 3
Identifier00169571
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. STEPHEN HOWELL GREEN
Title or Position: PARTNER
Credential: MD
Phone: 631-475-8846