Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 25MD002143 | NJ |
NPI | 1558358739 |
---|---|
Provider Name | Dr. William J Green |
First Address | Lumberton, NJ 08048-4617 |
Second Address | Burlington, NJ 08016-1343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 07/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0040897000 | AMERIHEALTH (01) | NJ |
0183361 | AETNA (01) | NJ |
1094025 | UNITED HEALTHCARE (01) | NJ |
1154339 | CIGNA (01) | NJ |
5486904 | (05) | NJ |
P3800567 | OXFORD (01) | NJ |
U33493 | (02) | NJ |