Healthcare Provider Details

I. General information

NPI: 1588652432
Provider Name (Legal Business Name): MARCIA ROSEMARIE GREENE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CASTLETON AVE FL 1
STATEN ISLAND NY
10310-1803
US

IV. Provider business mailing address

736 CASTLETON AVE FL 1
STATEN ISLAND NY
10310-1803
US

V. Phone/Fax

Practice location:
  • Phone: 718-273-8686
  • Fax: 718-273-2851
Mailing address:
  • Phone: 718-273-8686
  • Fax: 718-273-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number039401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: