Provider Demographics
NPI:1003206343
Name:GREENE, SELINA (LAC)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BROADWAY APT 6A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1660
Mailing Address - Country:US
Mailing Address - Phone:347-678-2293
Mailing Address - Fax:
Practice Address - Street 1:5000 BROADWAY APT 6A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1660
Practice Address - Country:US
Practice Address - Phone:347-678-2293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25 005517171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist