Provider Demographics
NPI:1265503189
Name:GREEN, DANIEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 29234
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-9234
Mailing Address - Country:US
Mailing Address - Phone:212-606-1631
Mailing Address - Fax:
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4823
Practice Address - Country:US
Practice Address - Phone:212-606-1631
Practice Address - Fax:212-774-2776
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036159207XP3100X
NY19074212086S0120X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010036159CT03OtherANTHEM BLUE CROSS
NY010190742NY01OtherANTHEM BLUE CROSS
NY01802368Medicaid
NY134027951OtherTHE EMPIRE PLAN
NY81G881OtherEMPIRE BLUE CROSS
NYP1122514OtherOXFORD HEALTH PLAN
NYP1122514OtherOXFORD HEALTH PLAN
NY134027951OtherTHE EMPIRE PLAN
NY01802368Medicaid