Provider Demographics
NPI:1942377486
Name:GREENE, CONSTANCE (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:GREENE
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 1:824 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2618
Mailing Address - Country:US
Mailing Address - Phone:716-652-9392
Mailing Address - Fax:
Practice Address - Street 1:6000 N BAILEY AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-5102
Practice Address - Country:US
Practice Address - Phone:716-834-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182221208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1209872OtherINDEPENDENT HEALTH
NY00010068306OtherBLUE SHIELD WNY
NY000511389008OtherUNIVERA
NYRA8977Medicare ID - Type Unspecified
NY000511389008OtherUNIVERA