Individual ProviderYaakov Samuel GreenStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address1051 Riverside Dr # 103, New York, NY 10032-1007(646) 774-6302PECOS EnrollmentBased on the most recent information from CMS, provider Yaakov Samuel Green does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1124761770Provider TypeIndividualFull NameGreen, Yaakov SamuelCredentialMDGenderMaleSole ProprietorNoEnumeration Date4/20/2022Last Updated8/21/2024Contact InformationPractice LocationPractice Address1051 Riverside Dr # 103, New York, NY 10032-1007Phone(646) 774-6302Fax(256) 662-6919Mailing LocationMailing Address1051 Riverside Dr # 103, New York, NY 10032-1007PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer