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Provider Information for 1336638238

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ALEXANDER GREEN DPM

Gender: MALE

Individual NPI: 1336638238

Calendar   Last Updated:  2018-05-07
  Certification Date: 

Details

Name Value
NPI 1336638238
Enumeration Date 2018-05-07
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 4433 VESTAL PKWY E FL 2
VESTAL, NY 13850-3556
United States

Phone: 607-772-8772 | Fax:
View Map External Link
Primary Practice Address 4433 VESTAL PKWY E FL 2
VESTAL, NY 13850-3556
United States

Phone: 607-772-8772 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 390200000X - Student in an Organized Health Care Education/Training Program