Provider Demographics
NPI:1669563862
Name:GREENE, PAUL ARTHUR (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ARTHUR
Last Name:GREENE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 LAMBERT LN
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-1010
Mailing Address - Country:US
Mailing Address - Phone:914-235-6171
Mailing Address - Fax:
Practice Address - Street 1:68 LAMBERT LN
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-1010
Practice Address - Country:US
Practice Address - Phone:914-235-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005968103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV1556200Medicare ID - Type UnspecifiedMEDICARE