Provider Demographics
NPI:1093337263
Name:GREENE, CASSANDRA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:LEE
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DE CAMP DR
Mailing Address - Street 2:
Mailing Address - City:BOONTON TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-8834
Mailing Address - Country:US
Mailing Address - Phone:201-650-0690
Mailing Address - Fax:
Practice Address - Street 1:901 US HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1419
Practice Address - Country:US
Practice Address - Phone:908-253-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11998200207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine