Provider Demographics
NPI:1104807106
Name:GREEN, HOWARD SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:SAMUEL
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MERRY LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1737
Mailing Address - Country:US
Mailing Address - Phone:516-587-7196
Mailing Address - Fax:516-935-2177
Practice Address - Street 1:53 MERRY LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1737
Practice Address - Country:US
Practice Address - Phone:516-587-7196
Practice Address - Fax:516-935-2177
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1384892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B78628Medicare UPIN