Provider Demographics
NPI:1639368749
Name:GREENE, ELLEN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:A
Last Name:GREENE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MADISON AVE
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1101
Mailing Address - Country:US
Mailing Address - Phone:212-532-1400
Mailing Address - Fax:212-532-4655
Practice Address - Street 1:275 MADISON AVE
Practice Address - Street 2:SUITE 2500
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1101
Practice Address - Country:US
Practice Address - Phone:212-532-1400
Practice Address - Fax:212-532-4655
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0343391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice