| Organization Name: | GREENE FAMILY MEDICINE, PLLC |
| NPI Number: | 1528216835 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARJORIE KETZAK (OWNER) |
| Mailing Address: | 29 N Chenango St Greene |
| State: | NY US |
| Postal Code: | 137781139 |
| Phone Number: | 6074274588 |
| Fax Number: | 6076565015 |
| NPI Enumeration Date: | 08/29/2008 |
| NPI Last Update Date: | 08/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |