Provider Demographics
NPI:1003047580
Name:DEBRA GREEN, MD PLLC
Entity Type:Organization
Organization Name:DEBRA GREEN, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-988-3801
Mailing Address - Street 1:115 E 57TH ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2049
Mailing Address - Country:US
Mailing Address - Phone:212-584-2619
Mailing Address - Fax:212-744-4072
Practice Address - Street 1:115 E 57TH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2049
Practice Address - Country:US
Practice Address - Phone:212-584-5402
Practice Address - Fax:212-744-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-02
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001687Medicare PIN