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Provider Information for 1447779350

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

BENITO GREEN

Gender: MALE

Individual NPI: 1447779350

Calendar   Last Updated:  2018-11-01
  Certification Date: 

Details

Name Value
NPI 1447779350
Enumeration Date 2017-09-12
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 8114 QUEENS BLVD
ELMHURST, NY 11373-3789
United States

Phone: 718-889-9810 | Fax: 718-899-9699
View Map External Link
Primary Practice Address 140-15B STANFORD
FLUSHING, NY 11355
United States

Phone: 718-358-8288 | Fax: 718-358-5265
View Map External Link
Secondary Practice Address 81-14 QUEENS BLVD
ELMHUSRT, NY 11373
United States

Phone: #(718) 889-9810212 | Fax: 718-899-9699
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
No 101YM0800X - Counselor Mental Health