Provider Demographics
NPI:1033406772
Name:GREEN, ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1156 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1108
Mailing Address - Country:US
Mailing Address - Phone:914-965-3700
Mailing Address - Fax:914-965-3883
Practice Address - Street 1:462 7TH AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7439
Practice Address - Country:US
Practice Address - Phone:917-334-3682
Practice Address - Fax:917-525-2133
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY40401395363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCY NPI NUMBER
NYWVE061OtherAGENCY MEDICARE #
NY00355940OtherAGENCY MEDICAID #