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General NPI Number Information
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NPI Number | 1790753523
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Entity Type | Individual
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Provider Name | DOUGLAS STEWART GREEN MD
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 12/21/2018
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Provider Practice Location Address
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Address Line | 1199 PLEASANT VALLEY WAY KESSLER INSTITUTE FOR REHABILITATION
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City | WEST ORANGE
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State | NJ
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Zip | 07052
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Country | US
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Telephone | 973-325-6210
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Fax | 973-243-6861
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Provider Business Mailing Address
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Address Line | 1199 PLEASANT VALLEY WAY KESSLER INSTITUTE FOR REHABILITATION
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City | WEST ORANGE
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State | NJ
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Zip | 07052
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Country | US
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Telephone | 973-325-6210
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Fax | 973-243-6861
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MA45011
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MA45011
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License Number State | NJ
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