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General NPI Number Information
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NPI Number | 1891831988
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Entity Type | Organization
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Legal Business Name | GREENE AVENUE MEDICAL PC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1350 GREENE AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-4902
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Country | US
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Telephone | 718-628-8216
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 GREENE AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-4902
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Country | US
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Telephone | 718-628-8216
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | GASTON STERLIN
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Credential |
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Telephone | 718-628-8216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 162991
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License Number State | NY
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