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Provider Information for 1740778497

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

MRS. CAROLYN RUTH GREEN PTA

Other Name:   CAROLYN LEE
Gender: FEMALE

Individual NPI: 1740778497

Calendar   Last Updated:  2018-04-27
  Certification Date: 

Details

Name Value
NPI 1740778497
Enumeration Date 2018-04-27
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 18920 42ND AVE FL 2
FLUSHING, NY 11358-2804
United States

Phone: 917-864-4196 | Fax:
View Map External Link
Primary Practice Address 5 DAKOTA DR STE 200
NEW HYDE PARK, NY 11042-1109
United States

Phone: 631-752-0400 | 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 225200000X - Physical Therapy Assistant NY 008819