Greene Avenue Medical, PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

157407 Issued in NY

Legal business name

GREENE AVENUE MEDICAL, PC

Practice address

1350 Greene Ave FL 2
Brooklyn, NY 11237-4902

Phone

(718) 628-8216

Fax

(718) 628-4755

NPI assigned

Dec 19, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elide Sterlin

Title

President/Trustee

Phone

(570) 972-7511

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Tax ID family

Greene Avenue Medical PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Greene Avenue Medical PC

  • Legal Medicine
  • Brooklyn, NY
  • NPI 1891831988
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph Thomas, MD

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1023082039
  Medicare reassignment NPD
• Wylene Barton Samad, NP

  • Family Nurse Practitioner
  • Brooklyn, NY
  • NPI 1689014292
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1482105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482105600000",
    "number": "1811431323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 GREENE AVE FL 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374902",
            "telephone_number": "718-628-8216",
            "fax_number": "718-628-4755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 GREENE AVE FL 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374902",
            "telephone_number": "718-628-8216",
            "fax_number": "718-628-4755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE AVENUE MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-19",
        "last_updated": "2016-12-19",
        "status": "A",
        "authorized_official_last_name": "STERLIN",
        "authorized_official_first_name": "ELIDE",
        "authorized_official_title_or_position": "PRESIDENT/TRUSTEE",
        "authorized_official_telephone_number": "570-972-7511"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "157407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rose Greenberger
• Carolyn Sara Greenblatt, PHD
• Melissa Greenblatt, LCSW
• Greencap Cleaning
• Greene Avenue Medical PC
• Allison Michelle Greene Jackson, LCSW
• Greene RX Inc
• Greene RX Inc
• Greene Van Pharmacy Corp
• Alicia Greene, LMSW

• Primary Care Clinic/Center in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.