Provider Demographics
NPI:1316465594
Name:GREENE, SPENCER PRESCOTT (MS TCM)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:PRESCOTT
Last Name:GREENE
Suffix:
Gender:M
Credentials:MS TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1254
Mailing Address - Country:US
Mailing Address - Phone:201-638-6338
Mailing Address - Fax:
Practice Address - Street 1:825 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-5419
Practice Address - Country:US
Practice Address - Phone:203-802-5453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT699171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist