Provider Demographics
NPI:1174548689
Name:GREEN, PETER WARWICK (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:WARWICK
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:554 LARKFIELD RD
Mailing Address - Street 2:STE 10G
Mailing Address - City:E NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-368-1222
Mailing Address - Fax:631-368-8401
Practice Address - Street 1:554 LARKFIELD RD
Practice Address - Street 2:STE 10G
Practice Address - City:E NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731
Practice Address - Country:US
Practice Address - Phone:631-368-1222
Practice Address - Fax:631-368-8401
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1431571207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY46D811Medicare PIN
C10132Medicare UPIN