Provider Demographics
NPI:1235644626
Name:CHANG-GREENE, LEONTYNE
Entity Type:Individual
Prefix:
First Name:LEONTYNE
Middle Name:
Last Name:CHANG-GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11834 201ST ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3527
Mailing Address - Country:US
Mailing Address - Phone:347-423-9672
Mailing Address - Fax:
Practice Address - Street 1:11834 201ST ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3527
Practice Address - Country:US
Practice Address - Phone:347-423-9672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567220163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management