Healthcare Provider Details

I. General information

NPI: 1013378439
Provider Name (Legal Business Name): CARLENE P. GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2016
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 PARK AVE
PLAINFIELD NJ
07060-2911
US

IV. Provider business mailing address

1416 PARK AVE
PLAINFIELD NJ
07060-2911
US

V. Phone/Fax

Practice location:
  • Phone: 908-757-6363
  • Fax: 908-754-6807
Mailing address:
  • Phone: 908-757-6363
  • Fax: 908-754-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ0107400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ006144400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: