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General NPI Number Information
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NPI Number | 1811102569
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Entity Type | Organization
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Legal Business Name | WARWICK GREEN M.B.B.S., P.C
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 554 LARKFIELD ROAD SUITE 10G
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City | EAST NORTHPORT
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State | NY
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Zip | 11731
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Country | US
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Telephone | 631-368-1222
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Fax | 631-368-8401
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Provider Business Mailing Address
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Address Line | 554 LARKFIELD ROAD SUITE 10G
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City | EAST NORTHPORT
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State | NY
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Zip | 11731
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Country | US
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Telephone | 631-368-1222
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Fax | 631-368-8401
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PEGGY OLSSEN
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Credential |
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Telephone | 631-368-1222
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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 | 1431571
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License Number State | NY
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