Healthcare Provider Details

I. General information

NPI: 1992669832
Provider Name (Legal Business Name): SHEA GREEN EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 ROUTE 59 # 3000
SUFFERN NY
10901-5322
US

IV. Provider business mailing address

296 ROUTE 59 # 3000
SUFFERN NY
10901-5322
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number462782
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: