Provider Demographics
NPI:1588652432
Name:GREENE, MARCIA ROSEMARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:ROSEMARIE
Last Name:GREENE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 CASTLETON AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1803
Mailing Address - Country:US
Mailing Address - Phone:718-273-8686
Mailing Address - Fax:718-273-2851
Practice Address - Street 1:736 CASTLETON AVE FL 1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1803
Practice Address - Country:US
Practice Address - Phone:718-273-8686
Practice Address - Fax:718-273-2851
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0394011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01007712Medicaid