Provider Demographics
NPI:1811102569
Name:WARWICK GREEN M.B.B.S., P.C
Entity type:Organization
Organization Name:WARWICK GREEN M.B.B.S., P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-368-1222
Mailing Address - Street 1:554 LARKFIELD ROAD
Mailing Address - Street 2:SUITE 10G
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-368-1222
Mailing Address - Fax:631-368-8401
Practice Address - Street 1:554 LARKFIELD ROAD
Practice Address - Street 2:SUITE 10G
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731
Practice Address - Country:US
Practice Address - Phone:631-368-1222
Practice Address - Fax:631-368-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1431571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1431571OtherLICENSE
NY1431571OtherLICENSE