MEDICARE: ANTOIN JOHN GREENE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1679107213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOIN JOHN GREENE

Provider Business Mailing Address
First Line	:	1200 LINCOLN AVE APT 30
Second Line	:
City	:	PROSPECT PARK
State	:	PA
Zip	:	19076-2007
Country	:	US
Telephone Number	:	484-510-6951
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 E BALTIMORE PIKE
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-1751
Country	:	US
Telephone Number	:	844-924-0777
Fax Number	:

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

Provider Enumeration Date	:	02/22/2020
Last Update Date	:	04/19/2026

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Directions to “ ANTOIN JOHN GREENE ” Practice Location

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