Provider Demographics
NPI:1487356762
Name:GREENIDGE, ORNESSA
Entity type:Individual
Prefix:MRS
First Name:ORNESSA
Middle Name:
Last Name:GREENIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 CLEVELAND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-5062
Mailing Address - Country:US
Mailing Address - Phone:347-856-3554
Mailing Address - Fax:
Practice Address - Street 1:921 CLEVELAND ST APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-5062
Practice Address - Country:US
Practice Address - Phone:347-856-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY559302889344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi