Provider Demographics
NPI:1619032794
Name:GREENE, RICHARD E (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MADISON ST FL 4
Mailing Address - Street 2:GOUVERNEUR HEALTHCARE SERVICES
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7537
Mailing Address - Country:US
Mailing Address - Phone:212-238-7532
Mailing Address - Fax:
Practice Address - Street 1:227 MADISON ST FL 4
Practice Address - Street 2:GOUVERNEUR HEALTHCARE SERVICES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT188432207RS0010X
NY233099207RS0010X
NJ25MA08102000207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60D1220811Medicare PIN