Provider Demographics
NPI:1053483073
Name:COLEY-GREEN, JUNIPER E II (BS)
Entity Type:Individual
Prefix:
First Name:JUNIPER
Middle Name:E
Last Name:COLEY-GREEN
Suffix:II
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 CROOKED HILL RD
Mailing Address - Street 2:BLDG42
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1043
Mailing Address - Country:US
Mailing Address - Phone:631-761-4153
Mailing Address - Fax:631-761-4184
Practice Address - Street 1:998 CROOKED HILL RD
Practice Address - Street 2:BLDG42
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1043
Practice Address - Country:US
Practice Address - Phone:631-761-4150
Practice Address - Fax:631-761-4184
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator