Individual
DR. GLENN J GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 GIDNEY AVE, NEWBURGH, NY 12550-3116
(845) 562-1100
(845) 562-1162
Mailing address
450 GIDNEY AVE, NEWBURGH, NY 12550-3116
(845) 562-1100
(845) 562-7762
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
149190
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00718525
—
NY
01
—
119190 1
OPTHALMOLOGIST RETINA
NY
01
—
149190
OPTHALMOLOGIST RETINA
NY
Enumeration date
09/30/2005
Last updated
09/08/2014
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