Provider Demographics
NPI:1164436770
Name:STEPHEN H GREEN MD FACS & STANLEY K KLAUSNER MD FACS LLP
Entity Type:Organization
Organization Name:STEPHEN H GREEN MD FACS & STANLEY K KLAUSNER MD FACS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:HOWELL
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-475-8846
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:BUILDING 2 SUITE A
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-475-8846
Mailing Address - Fax:631-475-8860
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BUILDING 2 SUITE A
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-475-8846
Practice Address - Fax:631-475-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099292208600000X
NY101835208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101835OtherLICENSE DR K
NY099292OtherLICENSE DR G
NY00169571Medicaid
81L441Medicare ID - Type UnspecifiedDR K
NY00169571Medicaid
B16050Medicare UPIN
NY101835OtherLICENSE DR K