Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 25MD00154200 | NJ |
N | 213ES0131X | Foot Surgery | 25MD00154200 | NJ |
NPI | 1467440537 |
---|---|
Provider Name | Dr. Joseph G Green JR. |
First Address | Matawan, NJ 07747-7031 |
Second Address | East Orange, NJ 07018-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |