Provider Demographics
NPI:1457083388
Name:GREEN NP IN ADULT HEALTH PLLC
Entity Type:Organization
Organization Name:GREEN NP IN ADULT HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MONGE
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:845-579-3435
Mailing Address - Street 1:5 WILLOW DOCK RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1215
Mailing Address - Country:US
Mailing Address - Phone:845-579-3435
Mailing Address - Fax:
Practice Address - Street 1:5 WILLOW DOCK RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1215
Practice Address - Country:US
Practice Address - Phone:845-579-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty