MR. KENNETH R. GREEN (NPI# 1114909512) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114909512 |
| Entity Type | Individual |
| Full Name | MR. KENNETH R. GREEN |
| Credential | M.D. |
| Practice Address |
1304 Buckley Rd Syracuse NY 13212-4302 |
| Mailing Address |
1304 Buckley Road Syracuse NY 13212 |
| Practice Telephone | 3154783311 |
| Practice Fax Number | 3154260796 |
| Mailing Telephone | 3154783311 |
| Mailing Fax Number | 3154260796 |
| Enumeration Date | 2005-11-19 |
| Last Update Date | 2008-02-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
130245 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | UNIVERA SENIOR CHOICE | 00040696502 | 01 |
| NY | MVP | 719956 | 01 |
| NY | AETNA | 4535679 | 01 |
| NY | HEALTHNOW | 00914917001 | 01 |
| NY | 00581475 | 05 | |
| NY | HEALTHNOW | 000914917001 | 01 |
| NY | UNITED HEALTHCARE | 100029112801 | 01 |
| NY | CDPHP | 10119425 | 01 |
| NY | GHI | 3300208 | 01 |
| NY | EXCELLUS | 03260 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699310466 | Kenneth Leroy Green Jr. | Durable Medical Equipment & Medical Supplies | 7939 W Gulf To Lake Hwy, Crystal River, FL 34429-7931 | 2019-11-15 |
| 1366964462 | Kenneth Walter Green | Massage Therapist | 307 Rockmoor Dr, Georgetown, TX 78628-8983 | 2017-07-10 |
| 1972828895 | Kenneth James Green | Social Worker | 2505 W 71st St, Indianapolis, IN 46268-2344 | 2010-04-03 |
| 1083623367 | Kenneth E Green | Family Medicine | 1895 Elizabethtown Rd, Leitchfield, KY 42754-9138 | 2006-08-05 |
| 1659366375 | Kenneth H Green | Optometrist | 4040 W Kennedy Blvd, Tampa, FL 33609-2750 | 2005-09-19 |
| 1427229194 | Kenneth Green | Social Worker | 408 S Broadview St, Cape Girardeau, MO 63703-5725 | 2008-03-20 |
| 1508802950 | Kenneth E Green | Surgery | 1025 New Moody Ln, La Grange, KY 40031-9154 | 2006-06-22 |
| 1245281716 | Kenneth Vincent Green | Social Worker | 102 Springhill Cir, Panama City, FL 32405-3546 | 2006-05-12 |
| 1649245614 | Kenneth Peter Green | Dentist | National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889-0001 | 2006-02-22 |
| 1780680900 | Kenneth O Green | Ophthalmology | 111 W Lincoln St, Belleville, IL 62220-2019 | 2005-06-22 |
| Street Address |
1304 BUCKLEY RD |
| City | SYRACUSE |
| State | NY |
| Zip Code | 13212-4302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528059995 | George O Temnycky | Ophthalmology | 1304 Buckley Rd, Suite 205, Syracuse, NY 13212-4311 | 2005-11-03 |
| 1265983696 | The Lasik Vision Institute LLC | Clinic/Center | 1304 Buckley Rd, 3rd Floor Suite 301, Syracuse, NY 13212-4311 | 2016-10-20 |
| 1922558048 | Liverpool Ld, LLC | Clinic/Center | 1304 Buckley Rd, Syracuse, NY 13212-4311 | 2016-10-13 |
| 1861949216 | Jessica Arcuri | Registered Nurse | 1304 Buckley Rd, Syracuse, NY 13212-4311 | 2016-09-01 |
| 1205237914 | Family Care Medical Group PC | Non-Pharmacy Dispensing Site | 1304 Buckley Rd, Suite 302, Syracuse, NY 13212-4311 | 2014-09-12 |
| 1881027332 | Constance Marie Chantry | Dietitian, Registered | 1304 Buckley Rd, Suite 200, Syracuse, NY 13212-4311 | 2013-08-19 |
| 1326308362 | Roksolana Stets | Dentist | 1304 Buckley Rd, Suite 203, Syracuse, NY 13212-4311 | 2012-05-24 |
| 1013176403 | Gordana Obradovic | Internal Medicine | 1304 Buckley Rd, Suite 200, Syracuse, NY 13212-4311 | 2008-06-02 |
| 1689843385 | Liverpool Dialysis Center LLC | Clinic/Center | 1304 Buckley Rd, Syracuse, NY 13212-4311 | 2008-02-27 |
| 1710183678 | Mounir Bashour | Ophthalmology | 1304 Buckley Rd, Suite 301, Syracuse, NY 13212-4302 | 2007-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750845749 | Branches of Growth Mental Health Counseling, Pllc | Counselor | 3709 Brewerton Rd, Syracruse, NY 13212 | 2019-01-24 |
| 1821574070 | Nadia Marie James | Licensed Practical Nurse | 7175 Rose Wood Circle, North Syracuse, NY 13212 | 2018-07-11 |
| 1306364534 | Shonna Jolene Brodhead | Social Worker | Brightpath Counseling, 7266 Buckley Road, North Syracuse, NY 13212 | 2017-09-08 |
| 1477915189 | Karen Filapello | Speech-Language Pathologist | 320 Gateway Park Drive, @ Precision Contractors, N. Syracuse, NY 13212 | 2016-03-22 |
| 1285017095 | Lacey Foster | Skilled Nursing Facility | 5991 East Taft Rd, North Syracuse, NY 13212 | 2015-06-30 |
| 1346500345 | Wahienhawi Hall | Counselor | 7266 Buckley Rd., Bright Path Counseling Center, North Syracuse, NY 13212 | 2012-05-23 |
| 1316253768 | Jenny Barnum | Nurse Practitioner | 5232 Witz Dr, North Syracuse, NY 13212 | 2010-08-24 |
| 1063738797 | Gregory 'greg' Procopio | Registered Nurse | 308 Charlane Parkway, North Syracuse, NY 13212 | 2010-04-20 |
| 1316142243 | Carrie Marie Vincent | Specialist | 401north Main Street, North Syracuse, NY 13212 | 2007-06-20 |
| 1245307594 | Lynda Robin Kreitzer | Podiatrist | 316 South Main Street, North Syracuse, NY 13212 | 2006-11-30 |
| Find all providers in zip 13212 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801203898 | Syed Hassan Raza Bukhari | Internal Medicine | 750 E Adams St # 343, Syracuse, NY 13210-2306 | 2014-07-22 |
| 1881113488 | Joanna Angela Woodruff | Internal Medicine | 1304 Buckley Rd Ste 200, Syracuse, NY 13212-4317 | 2017-09-14 |
| 1922409671 | Suthaharan Vimalendran | Internal Medicine | 6846 Buckley Road, Syracuse, NY 13212-4264 | 2014-09-12 |
| 1932525425 | Alia Hasan | Internal Medicine | 800 Irving Ave, Syracuse, NY 13210-2716 | 2014-03-09 |
| 1316235583 | Vikram Aggarwal | Internal Medicine | 750 E Adams St, Room 343 Cwb, Syracuse, NY 13210-2306 | 2011-07-21 |
| 1104057751 | Eric K. Ofori | Internal Medicine | 301 Prospect Avenue, Syracuse, NY 13203 | 2009-07-30 |
| 1407019730 | Antoine Azar | Internal Medicine | 1304 Buckley Road, Suite 200, Syracuse, NY 13212-4317 | 2008-07-07 |
| 1831276823 | Nephrology Associates of Syracuse, P.C. | Internal Medicine | 1304 Buckley Rd, Syracuse, NY 13212-4302 | 2006-11-01 |
| 1629154653 | Matthew G Chaffin | Internal Medicine | 1304 Buckley Road, Syracuse, NY 13212 | 2006-10-31 |
| 1760584411 | Bala K Murthy | Internal Medicine | 1304 Buckley Rd, Syracuse, NY 13212-4311 | 2006-09-02 |
| Find all providers in SYRACUSE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.