Provider Demographics
NPI:1215901475
Name:GREEN, STEPHEN G (MS DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:GREEN
Suffix:
Gender:M
Credentials:MS DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 WEBSTER AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924
Mailing Address - Country:US
Mailing Address - Phone:845-294-9990
Mailing Address - Fax:845-651-1460
Practice Address - Street 1:11 WEBSTER AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924
Practice Address - Country:US
Practice Address - Phone:845-294-9990
Practice Address - Fax:845-651-1460
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYX0036031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX21581Medicare ID - Type Unspecified