| Doctor Name: | MR. GEORGE EDWARD GREEN |
| NPI Number: | 1518333566 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 080340-1 |
| Business Practice Address: | 175 Riverside Drive Apt 9f New York, NY - 100241616 |
| Business Phone Number: | 2123620565 |
| Business Fax Number: | |
| Mailing Address: | 175 Riverside Drive, Apt 9f NEW YORK |
| State: | NY |
| Postal Code: | 100241616 |
| Phone Number: | 2123620565 |
| Fax Number: | |
| NPI Enumeration Date: | 08/13/2015 |
| NPI Last Update Date: | 08/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 080340-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |