Provider Demographics
NPI:1639154941
Name:GREEN, HOWARD C (DC)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:C
Last Name:GREEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 OLD NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5026
Mailing Address - Country:US
Mailing Address - Phone:631-249-0011
Mailing Address - Fax:631-249-1793
Practice Address - Street 1:1050 OLD NICHOLS RD
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5026
Practice Address - Country:US
Practice Address - Phone:631-249-0011
Practice Address - Fax:631-249-1793
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556324111N00000X
NC3382111N00000X
NYX007953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01768047Medicaid
NYX90711Medicare ID - Type Unspecified
NY01768047Medicaid