Provider Demographics
NPI:1861915050
Name:GREEN, TOWANA YOLANDA
Entity type:Individual
Prefix:
First Name:TOWANA
Middle Name:YOLANDA
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 HOYT ST APT 7B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2936
Mailing Address - Country:US
Mailing Address - Phone:917-686-7960
Mailing Address - Fax:
Practice Address - Street 1:10818 QUEENS BLVD STE 4A5TH
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4748
Practice Address - Country:US
Practice Address - Phone:212-804-7659
Practice Address - Fax:888-975-7704
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist