MEDICARE: MARCIA 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	F349580-01	NY

General Provider Information

NPI Number	:	1396676631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA GREEN

Provider Business Mailing Address
First Line	:	4198C BRONXWOOD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3156
Country	:	US
Telephone Number	:	347-322-7577
Fax Number	:

Provider Business Practice Location Address
First Line	:	4198C BRONXWOOD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3156
Country	:	US
Telephone Number	:	347-322-7577
Fax Number	:

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

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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Directions to “ MARCIA GREEN ” Practice Location

Language	Start Address	Practice Location

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