Provider Demographics
NPI:1174885354
Name:GREENE, MARJORIE AMANDA (RN)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:AMANDA
Last Name:GREENE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 FORT WASHINTON AVE.
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10033
Mailing Address - Country:US
Mailing Address - Phone:212-740-5157
Mailing Address - Fax:212-740-8566
Practice Address - Street 1:98 VIOLA AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4215
Practice Address - Country:US
Practice Address - Phone:973-246-3370
Practice Address - Fax:973-246-3370
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335003-1163WM0705X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical