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MR. KENNETH R. GREEN M.D.
NPI 1114909512
Internal Medicine - Nephrology in Syracuse, NY

Active since November 19, 2005
1304 BUCKLEY RD, SYRACUSE, NY 13212(315) 478-3311(315) 426-0796 Get Directions Write a Review

NPPES record last updated: February 14, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Kenneth R. Green M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. KENNETH R. GREEN M.D. (NPI 1114909512) is an individual nephrology provider in Syracuse, New York, licensed in New York (130245) and active in the NPI registry since November 2005.

NPPES Registry Identity

NPI1114909512
Entity TypeIndividualMale
Primary Taxonomy207RN0300X
Provider Legal NameMR. KENNETH R. GREENCredential: M.D.
Location Address1304 BUCKLEY RDSyracuse, NY 13212-4302
Mailing Address1304 Buckley RoadSyracuse, NY 13212 · (315) 478-3311 · Fax (315) 426-0796
Phone(315) 478-3311
Fax(315) 426-0796
Sole ProprietorNo
Enumeration DateNovember 19, 2005
Last NPPES UpdateFebruary 14, 2008
✔ NPI 1114909512 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
License✔ Licensed in NY · 130245
Definition
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.
1304 BUCKLEY RD, Syracuse, NY 13212
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Other Identifiers 13

Other4535679NY · Aetna
Medicaid00581475NY
Other000914917001NY · Healthnow
Other100029112801NY · United Healthcare
Medicare UPINB81067NY
Other719956NY · Mvp
Other00914917001NY · Healthnow
Other00040696502NY · Univera Senior Choice
Other03260NY · Excellus
Medicare ID-Type Unspecified34576CNY
Other10119425NY · Cdphp
Other3300208NY · Ghi
Medicare OSCAR/certification51136NNY

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GORDANA OBRADOVIC M.D.
Internal Medicine (Nephrology)
1304 BUCKLEY RD, SUITE 200
SYRACUSE, NY 13212
Onondaga County (315) 478-3311
ELIAS S. ABBOUD O.D.
Optometrist
1304 BUCKLEY RD, STE 205
SYRACUSE, NY 13212
Onondaga County (315) 458-2020
DR. SIMARDEEP MANGAT MD
Internal Medicine (Nephrology)
1304 BUCKLEY RD
SYRACUSE, NY 13212
Onondaga County (315) 478-3311
DR. RICHARD T KOPECKY M.D.
Internal Medicine (Nephrology)
1304 BUCKLEY RD
SYRACUSE, NY 13212
Onondaga County (315) 478-3311
DR. ROBYN M WENMAN DDS
Dentist (General Practice)
1304 BUCKLEY RD, SUITE 203
SYRACUSE, NY 13212
Onondaga County (315) 474-1711
MARCIA H RYDER N.P.
Nurse Practitioner
1304 BUCKLEY RD
SYRACUSE, NY 13212
Onondaga County (315) 478-3311
CHELSEY AZER NP
Nurse Practitioner (Family)
1304 BUCKLEY RD
SYRACUSE, NY 13212
Onondaga County (315) 671-5790
FAMILY CARE MEDICAL GROUP PC
Non-Pharmacy Dispensing Site
1304 BUCKLEY RD, SUITE 302
SYRACUSE, NY 13212
Onondaga County (315) 671-5790

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Green's NPI number?

The NPI number for Kenneth Green is 1114909512. It was assigned to this individual provider in the NPPES registry on November 19, 2005.

Where is Kenneth Green located?

Kenneth Green practices at 1304 Buckley Rd, Syracuse, NY 13212. The listed phone number is (315) 478-3311.

What is Kenneth Green's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

When was this NPI record last updated?

The NPPES record for Kenneth Green was last updated on February 14, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.