Provider Demographics
NPI:1679618904
Name:GREENE, MIRIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E 34TH ST
Mailing Address - Street 2:1CD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 E 34TH ST
Practice Address - Street 2:SUITE 1CD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4978
Practice Address - Country:US
Practice Address - Phone:212-725-3966
Practice Address - Fax:212-685-4316
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171513207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24F131Medicare ID - Type Unspecified
NYE17262Medicare UPIN