Healthcare Provider Details

I. General information

NPI: 1750322442
Provider Name (Legal Business Name): ROXANNE HOBBS-GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21789 HEMPSTEAD AVE
QUEENS VILLAGE NY
11429-1228
US

IV. Provider business mailing address

21789 HEMPSTEAD AVE
QUEENS VILLAGE NY
11429-1228
US

V. Phone/Fax

Practice location:
  • Phone: 718-217-0004
  • Fax: 718-217-0005
Mailing address:
  • Phone: 718-217-0004
  • Fax: 718-217-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number181769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: