Individual
MR. KENNETH R. GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1304 BUCKLEY RD, SYRACUSE, NY 13212-4302
(315) 478-3311
(315) 426-0796
Mailing address
1304 BUCKLEY ROAD, SYRACUSE, NY 13212
(315) 478-3311
(315) 426-0796
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
130245
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00040696502
UNIVERA SENIOR CHOICE
NY
01
—
000914917001
HEALTHNOW
NY
05
—
00581475
—
NY
01
—
00914917001
HEALTHNOW
NY
01
—
03260
EXCELLUS
NY
01
—
100029112801
UNITED HEALTHCARE
NY
01
—
10119425
CDPHP
NY
01
—
3300208
GHI
NY
01
—
4535679
AETNA
NY
01
—
719956
MVP
NY
Enumeration date
11/19/2005
Last updated
02/14/2008
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