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General NPI Number Information
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NPI Number | 1174907653
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Entity Type | Individual
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Provider Name | JENNA ALEXIS GREEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 170 WILLIAM ST LOWER MANHATTAN HOSPITAL SURGICAL SERVICES
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City | NEW YORK
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State | NY
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Zip | 10038-2612
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Country | US
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Telephone | 646-962-5131
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Fax |
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Provider Business Mailing Address
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Address Line | 153 E 57TH ST 8A
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City | NEW YORK
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State | NY
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Zip | 10022-2119
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Country | US
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Telephone | 551-427-8552
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 23018781
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License Number State | NY
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