Provider Demographics
NPI:1598904864
Name:GREENIDGE, HUGH HENDERSON (LPN)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:HENDERSON
Last Name:GREENIDGE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22546 MURDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2729
Mailing Address - Country:US
Mailing Address - Phone:646-269-9764
Mailing Address - Fax:718-465-1813
Practice Address - Street 1:22546 MURDOCK AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2729
Practice Address - Country:US
Practice Address - Phone:646-269-9764
Practice Address - Fax:718-465-1813
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228311-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse