Provider Demographics
NPI:1316560378
Name:GREEN FLASH PHYSICIAN OVERSIGHT PC
Entity type:Organization
Organization Name:GREEN FLASH PHYSICIAN OVERSIGHT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MOREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-273-4092
Mailing Address - Street 1:198 SUSSEX DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3737
Mailing Address - Country:US
Mailing Address - Phone:172-734-0929
Mailing Address - Fax:
Practice Address - Street 1:2868 BAYSIDE WALK UNIT C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-8119
Practice Address - Country:US
Practice Address - Phone:917-273-4092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty