Provider Demographics
NPI:1669286548
Name:GREEN, GEORGIAN OLIVER
Entity type:Individual
Prefix:
First Name:GEORGIAN
Middle Name:OLIVER
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:12603-4411
Mailing Address - Country:US
Mailing Address - Phone:845-546-6486
Mailing Address - Fax:
Practice Address - Street 1:7 WOOD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:NY
Practice Address - Zip Code:12603-4411
Practice Address - Country:US
Practice Address - Phone:845-546-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347979164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse