=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710903638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICE GREENE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 05/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 N MAY AVE STE 310
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-4291
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-229-2211
-----------------------------------------------------
Fax | 844-527-9397
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 W 99TH ST APT A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-5402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-681-3067
-----------------------------------------------------
Fax | 917-970-9544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 198080
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------