Provider Demographics
NPI:1124002597
Name:GREEN, LESLIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:GREEN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1 HATFIELD LN
Mailing Address - Street 2:STE 3 EYE PHYSICIANS OF ORANGE COUNTY PC
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6752
Mailing Address - Country:US
Mailing Address - Phone:845-294-5128
Mailing Address - Fax:845-294-1479
Practice Address - Street 1:1 HATFIELD LN
Practice Address - Street 2:STE 3 EYE PHYSICIANS OF ORANGE COUNTY PC
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6752
Practice Address - Country:US
Practice Address - Phone:845-294-5128
Practice Address - Fax:845-294-1479
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2013-01-14
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Provider Licenses
StateLicense IDTaxonomies
NY149367207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00837976Medicaid
NY00837976Medicaid
20D311Medicare ID - Type Unspecified