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NPI Code Detail

MEDICARE: DR. YISROEL GREEN DPT

MEDICARE: DR. YISROEL GREEN DPT
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
1225100000XPhysical Therapist046709NY

General Provider Information

NPI Number : 1750977096
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. YISROEL GREEN DPT
Provider Business Mailing Address
First Line : 1136 E 3RD ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-3338
Country : US
Telephone Number : 347-534-6565
Fax Number :
Provider Business Practice Location Address
First Line : 1716 CONEY ISLAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-5801
Country : US
Telephone Number : 718-336-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2020
Last Update Date : 12/20/2020

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