Provider Demographics
NPI:1881607810
Name:GREENE, LOREN WISSNER (MD)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:WISSNER
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:650 1ST AVE
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3240
Mailing Address - Country:US
Mailing Address - Phone:212-263-7449
Mailing Address - Fax:212-263-5574
Practice Address - Street 1:650 FIRST AVENUE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3240
Practice Address - Country:US
Practice Address - Phone:212-263-7449
Practice Address - Fax:212-263-5574
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY127405207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO7391Medicare UPIN
NY26A401Medicare ID - Type Unspecified