Provider Demographics
NPI:1558109702
Name:GREENE, ALEXANDER ELIJAH
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ELIJAH
Last Name:GREENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32006 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1907
Mailing Address - Country:US
Mailing Address - Phone:440-616-0082
Mailing Address - Fax:
Practice Address - Street 1:32006 GROVE ST
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1907
Practice Address - Country:US
Practice Address - Phone:440-616-0082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle