Provider Demographics
NPI:1154301000
Name:GREEN, RICHARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CENTRAL PARK S
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1436
Mailing Address - Country:US
Mailing Address - Phone:212-262-2500
Mailing Address - Fax:212-246-0890
Practice Address - Street 1:2100 BARTOW AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4614
Practice Address - Country:US
Practice Address - Phone:718-671-1000
Practice Address - Fax:212-765-3210
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY79669207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
143991OtherBLUE CROSS BLUE SHIELD
P62303155OtherMULTIPLAN
P853378OtherOXFORD
1935505OtherCIGNA
P62303155OtherMULTIPLAN
P853378OtherOXFORD