Provider Demographics
NPI:1588496541
Name:GREENE, JELANI K (DPT)
Entity type:Individual
Prefix:DR
First Name:JELANI
Middle Name:K
Last Name:GREENE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2438 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2244
Mailing Address - Country:US
Mailing Address - Phone:716-873-9154
Mailing Address - Fax:716-873-9154
Practice Address - Street 1:2438 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2244
Practice Address - Country:US
Practice Address - Phone:716-873-9154
Practice Address - Fax:716-873-9154
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052708-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist