Provider Demographics
NPI:1184032336
Name:GREEN, BISHOP
Entity Type:Individual
Prefix:
First Name:BISHOP
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11231 DILLON ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-3826
Mailing Address - Country:US
Mailing Address - Phone:516-451-7670
Mailing Address - Fax:718-657-0193
Practice Address - Street 1:11231 DILLON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-3826
Practice Address - Country:US
Practice Address - Phone:516-451-7670
Practice Address - Fax:718-657-0193
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY900677972OtherTRANSPORTATION