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General NPI Number Information
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NPI Number | 1063714988
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Entity Type | Organization
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Legal Business Name | GREEN DIAGNOSTIC IMAGING PC
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 4640 LIVINGSTON AVE
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City | BRONX
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State | NY
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Zip | 10471-3335
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Country | US
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Telephone | 917-608-2277
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Fax |
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Provider Business Mailing Address
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Address Line | 4640 LIVINGSTON AVE
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City | BRONX
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State | NY
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Zip | 10471-3335
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DAVID A GREEN
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Credential |
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Telephone | 917-608-2277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 195970
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License Number State | NY
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