Individual
MRS. CAROLYN RUTH GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5 DAKOTA DR STE 200, NEW HYDE PARK, NY 11042-1109
(631) 752-0400
Mailing address
18920 42ND AVE FL 2, FLUSHING, NY 11358-2804
(917) 864-4196
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
008819
NY
Other
Enumeration date
04/27/2018
Last updated
04/27/2018
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