Provider Demographics
NPI:1306085824
Name:GIBSON-GREEN, EILEEN L (OTR/L)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:L
Last Name:GIBSON-GREEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BRONX PARK E
Mailing Address - Street 2:APT.6C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6711
Mailing Address - Country:US
Mailing Address - Phone:718-652-2907
Mailing Address - Fax:
Practice Address - Street 1:3000 BRONX PARK E
Practice Address - Street 2:APT.6C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6711
Practice Address - Country:US
Practice Address - Phone:718-652-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0031511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist