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General NPI Number Information
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NPI Number | 1144622382
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Entity Type | Individual
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Provider Name | JONATHAN GREEN FNP
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Gender | Male
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 1825 EASTCHESTER RD
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City | BRONX
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State | NY
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Zip | 10461-2301
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Country | US
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Telephone | 718-904-3012
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Fax |
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Provider Business Mailing Address
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Address Line | 51 BERKSHIRE PL
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City | ALLENDALE
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State | NJ
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Zip | 07401-2005
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Country | US
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Telephone | 518-729-6155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 624738
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 339165
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ01036100
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License Number State | NJ
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