Provider Demographics
NPI:1093255796
Name:GREEN, NORRIS ALAN III (LMT)
Entity Type:Individual
Prefix:
First Name:NORRIS
Middle Name:ALAN
Last Name:GREEN
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 HERBERTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2805
Mailing Address - Country:US
Mailing Address - Phone:732-228-1419
Mailing Address - Fax:
Practice Address - Street 1:2908 HERBERTSVILLE RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2805
Practice Address - Country:US
Practice Address - Phone:732-228-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01084000225700000X
PAMSG008511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist