Provider Demographics
NPI:1518406180
Name:GREEN STREET MEDICAL
Entity Type:Organization
Organization Name:GREEN STREET MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-750-0506
Mailing Address - Street 1:898 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2121
Mailing Address - Country:US
Mailing Address - Phone:732-750-0506
Mailing Address - Fax:
Practice Address - Street 1:898 GREEN ST
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2121
Practice Address - Country:US
Practice Address - Phone:732-750-0506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04182100261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service