Doctor Name: | DR. JUSTIN JACOB GREEN |
NPI Number: | 1104894872 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 25MA07058200 |
Business Practice Address: | 100 Brick Rd Suite 306 Marlton, NJ - 080532146 |
Business Phone Number: | 8565960111 |
Business Fax Number: | 8565967194 |
Mailing Address: | 100 Brick Rd, Suite 306 MARLTON |
State: | NJ |
Postal Code: | 080532146 |
Phone Number: | 8565960111 |
Fax Number: | 8565967194 |
NPI Enumeration Date: | 03/09/2006 |
NPI Last Update Date: | 10/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 25MA07058200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |