Healthcare Provider Details

I. General information

NPI: 1538247986
Provider Name (Legal Business Name): FIVE TOWNS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 FRANKLIN PL
WOODMERE NY
11598-1218
US

IV. Provider business mailing address

145 FRANKLIN PL
WOODMERE NY
11598-1218
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-1200
  • Fax:
Mailing address:
  • Phone: 516-295-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM I GREEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 516-295-1200