Provider Demographics
NPI:1306853205
Name:GREEN, PETER HR (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HR
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 FORT WASHINGTON AVENUE
Mailing Address - Street 2:HARKNESS PAVILLION, SUITE 956
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-5590
Mailing Address - Fax:212-305-3738
Practice Address - Street 1:180 FORT WASHINGTON AVE
Practice Address - Street 2:HARKNESS PAVILLION, SUITE 956
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3735
Practice Address - Country:US
Practice Address - Phone:212-305-5590
Practice Address - Fax:212-305-3738
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY134307207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS1193OtherOXFORD PROVIDER ID
NY337611Medicare ID - Type Unspecified
NYB80423Medicare UPIN