Healthcare Provider Details

I. General information

NPI: 1134944499
Provider Name (Legal Business Name): DARREN RANDOLPH GREENE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 MADISON ST
SYRACUSE NY
13210-2338
US

IV. Provider business mailing address

3839 YORKLAND DR NW APT 12
COMSTOCK PARK MI
49321-8461
US

V. Phone/Fax

Practice location:
  • Phone: 315-426-3632
  • Fax: 315-426-3603
Mailing address:
  • Phone: 202-256-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number955394-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number955394-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: