Provider Demographics
NPI:1922762855
Name:GREEN, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135-23 78TH ROAD
Mailing Address - Street 2:REAR ENTRANCE
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135-23 78TH ROAD
Practice Address - Street 2:REAR ENTRANCE
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3239
Practice Address - Country:US
Practice Address - Phone:201-688-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program