Green, Kenneth R.

Green, Kenneth R. is an individual health care provider with primary practice located at 1304 Buckley Rd , Syracuse NY 13212-4302. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Green, Kenneth R. can be contacted via phone (315) 478-3311.

Contact Information

Primary practice address
1304 Buckley Rd Syracuse NY 13212-4302
Fax: (315) 426-0796
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 130245 New York

Profile Details

NPI number 1114909512
LBN Legal business name Green, Kenneth R.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 19th, 2005
Last updated Feb 14th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114909512 NPPES
New York Other 10119425 CDPHP
New York Other 000914917001 CDPHP
New York Other 3300208 CDPHP
New York Other 00914917001 CDPHP
New York Other 100029112801 CDPHP
New York Other 719956 CDPHP
New York MEDICAID 00581475 CDPHP
New York Other 03260 CDPHP
New York Other 00040696502 CDPHP
New York Other 4535679 CDPHP

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