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General NPI Number Information
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NPI Number | 1912994328
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Entity Type | Individual
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Provider Name | GLENN J GREEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 450 GIDNEY AVE
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City | NEWBURGH
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State | NY
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Zip | 12550-3116
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Country | US
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Telephone | 845-562-1100
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Fax | 845-562-1162
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Provider Business Mailing Address
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Address Line | 450 GIDNEY AVE
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City | NEWBURGH
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State | NY
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Zip | 12550-3116
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Country | US
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Telephone | 845-562-1100
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Fax | 845-562-7762
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 149190
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License Number State | NY
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