Basic Information
Provider Information
NPI: 1598945776
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GREENE
FirstName: DAVID
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 275 MADISON AVE
Address2: SUITE 2500
City: NEW YORK
State: NY
PostalCode: 100161101
CountryCode: US
TelephoneNumber: 2125321400
FaxNumber: 2125324655
Practice Location
Address1: 275 MADISON AVE
Address2: SUITE 2500
City: NEW YORK
State: NY
PostalCode: 100161101
CountryCode: US
TelephoneNumber: 2125321400
FaxNumber: 2125324655
Other Information
ProviderEnumerationDate: 11/06/2007
LastUpdateDate: 11/06/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X033275NYY Dental ProvidersDentistGeneral Practice

No ID Information.


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