Provider Demographics
NPI:1538414131
Name:GREEN, SOPHIA EDUKERE
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:EDUKERE
Last Name:GREEN
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 1:140 ASCH LOOP
Mailing Address - Street 2:APT. 2C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4033
Mailing Address - Country:US
Mailing Address - Phone:914-668-8938
Mailing Address - Fax:914-668-2545
Practice Address - Street 1:6 GRAMATAN AVE STE 401
Practice Address - Street 2:C/O WJCS
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3209
Practice Address - Country:US
Practice Address - Phone:914-668-8938
Practice Address - Fax:914-668-2545
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program