Provider Demographics
NPI:1457083388
Name:GREEN NP IN ADULT HEALTH PLLC
Entity type:Organization
Organization Name:GREEN NP IN ADULT HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MONGE
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:845-579-3435
Mailing Address - Street 1:1 BUSHWICK RD STE C
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3839
Mailing Address - Country:US
Mailing Address - Phone:845-579-3435
Mailing Address - Fax:845-243-2100
Practice Address - Street 1:1 BUSHWICK RD STE C
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3839
Practice Address - Country:US
Practice Address - Phone:845-579-3435
Practice Address - Fax:845-243-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07468940Medicaid