Organization
BRONX EAR NOSE & THROAT ASSOCIATE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEACROFT GREEN MD (OWNER)
(718) 409-2780
Entity
Organization
Contact information
Practice address
3250 WESTCHESTER AVE, STE #204, BRONX, NY 10461
(718) 409-2780
(718) 409-2786
Mailing address
3250 WESTCHESTER AVE, STE #204, BRONX, NY 10461
(718) 409-2780
(718) 409-2786
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
195521
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01677572
—
NY
Enumeration date
11/21/2006
Last updated
11/16/2020
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