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Provider Information for 1861014052

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

BRENDA GREEN NP

Gender: FEMALE

Individual NPI: 1861014052

Calendar   Last Updated:  2020-05-11
  Certification Date:  2020-05-11

Details

Name Value
NPI 1861014052
Enumeration Date 2020-05-11
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 5075 FIELDSTON RD
BRONX, NY 10471-2909
United States

Phone: 347-330-9102 | Fax:
View Map External Link
Primary Practice Address 6301 RIVERDALE AVE
BRONX, NY 10471-1046
United States

Phone: 347-330-9102 | Fax:
View Map External Link
Secondary Practice Address 5075 FIELDSTON RD
BRONX, NY 10471-2909
United States

Phone: 347-330-9102 | 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 363LF0000X - Nurse Practitioner Family NY 344282