MEDICARE: DR. RICHARD W 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	207N00000X	Dermatology Physician	79669	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	143991	OTHER	BLUE CROSS BLUE SHIELD
2	P62303155	OTHER	MULTIPLAN
3	P853378	OTHER	OXFORD
4	1935505	OTHER	CIGNA

General Provider Information

NPI Number	:	1154301000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD W GREEN MD

Provider Business Mailing Address
First Line	:	200 CENTRAL PARK S
Second Line	:	SUITE 107
City	:	NEW YORK
State	:	NY
Zip	:	10019-1436
Country	:	US
Telephone Number	:	212-262-2500
Fax Number	:	212-246-0890

Provider Business Practice Location Address
First Line	:	2100 BARTOW AVE
Second Line	:	SUITE 211
City	:	BRONX
State	:	NY
Zip	:	10475-4614
Country	:	US
Telephone Number	:	718-671-1000
Fax Number	:	212-765-3210

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	12/18/2014

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