Provider Demographics
NPI:1992779870
Name:GREENE, CHARLES STEVEN (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:STEVEN
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2354
Mailing Address - Country:US
Mailing Address - Phone:845-471-5519
Mailing Address - Fax:845-471-2928
Practice Address - Street 1:241 NORTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1154
Practice Address - Country:US
Practice Address - Phone:845-483-5253
Practice Address - Fax:845-485-3804
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1308292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00868740Medicaid
NY300124790Medicare PIN
NY35D841Medicare ID - Type Unspecified
NY00868740Medicaid