Provider Demographics
NPI:1790899482
Name:GREEN, DAVID N (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
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 1:7 MUNRO BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3304
Mailing Address - Country:US
Mailing Address - Phone:516-791-6421
Mailing Address - Fax:516-791-6423
Practice Address - Street 1:7 MUNRO BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3304
Practice Address - Country:US
Practice Address - Phone:516-791-6421
Practice Address - Fax:516-791-6423
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX13931Medicare ID - Type Unspecified
NYT52076Medicare UPIN