Provider Demographics
NPI:1760751184
Name:GREEN, HARRY SEAN JR (LPN)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:SEAN
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 E 6TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7038
Mailing Address - Country:US
Mailing Address - Phone:607-794-4494
Mailing Address - Fax:
Practice Address - Street 1:809 E 6TH ST APT 3B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-7038
Practice Address - Country:US
Practice Address - Phone:607-794-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306056-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse