MEDICARE: YAAKOV SAMUEL GREEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	325659	NY

General Provider Information

NPI Number	:	1124761770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAAKOV SAMUEL GREEN MD

Provider Business Mailing Address
First Line	:	1051 RIVERSIDE DR # 103
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 RIVERSIDE DR # 103
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1007
Country	:	US
Telephone Number	:	646-774-6302
Fax Number	:	256-662-6919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	06/05/2026

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