Provider Demographics
NPI:1164438065
Name:GREEN, KAREN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:775 PARK AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3976
Mailing Address - Country:US
Mailing Address - Phone:631-367-5395
Mailing Address - Fax:631-351-4561
Practice Address - Street 1:775 PARK AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3976
Practice Address - Country:US
Practice Address - Phone:631-367-5395
Practice Address - Fax:631-351-4561
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147226-1207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN92837OtherHEALTHNET
NY14D723OtherBLUE CROSS/ BLUE SHIELD
NYCS114OtherOXFORD
NY14D721Medicare ID - Type Unspecified
NY14D723OtherBLUE CROSS/ BLUE SHIELD