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General NPI Number Information
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NPI Number | 1518759604
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Entity Type | Organization
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Legal Business Name | GREENTHUMB REVENUE LLC
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 10 WILLIAMS WAY
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City | OCEAN VIEW
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State | NJ
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Zip | 08230-1206
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Country | US
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Telephone | 716-998-6842
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Fax |
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Provider Business Mailing Address
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Address Line | 10 WILLIAMS WAY
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City | OCEAN VIEW
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State | NJ
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Zip | 08230-1206
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Country | US
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Telephone | 716-998-6842
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VANESSA PEARSON
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Credential |
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Telephone | 716-998-6842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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