Provider Demographics
NPI:1750322442
Name:HOBBS-GREEN, ROXANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:HOBBS-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 1:21789 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1228
Mailing Address - Country:US
Mailing Address - Phone:718-217-0004
Mailing Address - Fax:718-217-0005
Practice Address - Street 1:21789 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-1228
Practice Address - Country:US
Practice Address - Phone:718-217-0004
Practice Address - Fax:718-217-0005
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01724203Medicaid
NYG26152Medicare UPIN
NY9255RGMedicare ID - Type Unspecified