Healthcare Provider Details

I. General information

NPI: 1457083388
Provider Name (Legal Business Name): GREEN NP IN ADULT HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BUSHWICK RD STE C
POUGHKEEPSIE NY
12603-3839
US

IV. Provider business mailing address

1 BUSHWICK RD STE C
POUGHKEEPSIE NY
12603-3839
US

V. Phone/Fax

Practice location:
  • Phone: 845-579-3435
  • Fax: 845-243-2100
Mailing address:
  • Phone: 845-579-3435
  • Fax: 845-243-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MONGE O'CONNELL
Title or Position: OWNER
Credential: NP
Phone: 845-579-3435