Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MA068977 | NJ |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MA06897700 | NJ |
NPI | 1194799346 |
---|---|
Provider Name | Dr. Michael J Greller |
First Address | Freehold, NJ 07728-7904 |
Second Address | Freehold, NJ 07728-7904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 30/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H16223 | (02) | NJ |