MEDICARE: DIANE GREEN

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	363LF0000X	Family Nurse Practitioner	F35236701	NY

General Provider Information

NPI Number	:	1174900419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE GREEN

Provider Business Mailing Address
First Line	:	91 31 QUEENS BLVD
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-9997
Country	:	US
Telephone Number	:	718-779-7000
Fax Number	:	718-697-6167

Provider Business Practice Location Address
First Line	:	9131 QUEENS BVLD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11373-9997
Country	:	US
Telephone Number	:	718-779-7000
Fax Number	:	718-697-6167

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

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	08/02/2023

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Directions to “ DIANE GREEN ” Practice Location

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