Provider Demographics
NPI:1467497701
Name:GREEN, SANFORD MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:MICHAEL
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W 73RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2700
Mailing Address - Country:US
Mailing Address - Phone:212-595-8200
Mailing Address - Fax:212-496-2588
Practice Address - Street 1:240 W 73RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2700
Practice Address - Country:US
Practice Address - Phone:212-595-8200
Practice Address - Fax:212-496-2588
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003187213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695758Medicaid
NY00695758Medicaid
NYP36001Medicare ID - Type Unspecified