Provider Demographics
NPI:1508602954
Name:GREEN, ALBERT STERLING (FNP)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:STERLING
Last Name:GREEN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PARK AVE # A
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:NY
Mailing Address - Zip Code:12170-1101
Mailing Address - Country:US
Mailing Address - Phone:518-944-4008
Mailing Address - Fax:
Practice Address - Street 1:1694 ROUTE 9
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-8816
Practice Address - Country:US
Practice Address - Phone:518-930-7486
Practice Address - Fax:518-930-7487
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program