Provider Demographics
NPI:1942879978
Name:GREENE, SYDNEY (RDN)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 KEISEL LN
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-4033
Mailing Address - Country:US
Mailing Address - Phone:267-664-7826
Mailing Address - Fax:
Practice Address - Street 1:30 CAMERON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2020
Practice Address - Country:US
Practice Address - Phone:267-664-7826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86054675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered