Provider Demographics
NPI:1932517471
Name:GREEN, JEFFREY (MS, ATC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6934 WILLIAMS RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3080
Mailing Address - Country:US
Mailing Address - Phone:716-298-5903
Mailing Address - Fax:
Practice Address - Street 1:6934 WILLIAMS RD
Practice Address - Street 2:SUITE 600
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3080
Practice Address - Country:US
Practice Address - Phone:716-298-5903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY67 0015832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer