Provider Demographics
NPI:1710903638
Name:GREENE, ALICE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:GREENE
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 1:315 W 99TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5402
Mailing Address - Country:US
Mailing Address - Phone:631-681-3067
Mailing Address - Fax:917-970-9544
Practice Address - Street 1:157 E. 86TH STREET, #469
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:917-444-7367
Practice Address - Fax:917-970-9544
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01846262Medicaid
NY53S532OtherEMPIRE BC.BS
NY7590416OtherAETNA
NY53S532OtherEMPIRE BC.BS
NY01846262Medicaid