Provider Demographics
NPI:1629040829
Name:GREEN, SHERYL (MD)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
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:PO BOX 12097
Mailing Address - Street 2:MT SINAI RADIATION ONCOLOGY
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-5097
Mailing Address - Country:US
Mailing Address - Phone:212-241-7500
Mailing Address - Fax:
Practice Address - Street 1:1184 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6503
Practice Address - Country:US
Practice Address - Phone:212-241-7500
Practice Address - Fax:212-410-7194
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1983412085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01607565Medicaid
NY201902Medicare ID - Type Unspecified
NY01607565Medicaid