Provider Demographics
NPI:1699760595
Name:GREENE, RENEE Y (AUD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:Y
Last Name:GREENE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 HENRY HUDSON PKWY
Mailing Address - Street 2:SUITE 12B
Mailing Address - City:RIVERDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1527
Mailing Address - Country:US
Mailing Address - Phone:718-548-6583
Mailing Address - Fax:718-548-0711
Practice Address - Street 1:3725 HENRY HUDSON PKWY
Practice Address - Street 2:SUITE 12B
Practice Address - City:RIVERDALE
Practice Address - State:NY
Practice Address - Zip Code:10463-1527
Practice Address - Country:US
Practice Address - Phone:718-548-6583
Practice Address - Fax:718-548-0711
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000122231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02866668Medicaid
NYM75021Medicare ID - Type Unspecified