Provider Demographics
NPI:1528384286
Name:GREEN, BRYNE EDWARD SR
Entity Type:Individual
Prefix:MR
First Name:BRYNE
Middle Name:EDWARD
Last Name:GREEN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HARDING HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PITTGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318
Mailing Address - Country:US
Mailing Address - Phone:856-358-4111
Mailing Address - Fax:
Practice Address - Street 1:90 HARDING HIGHWAY
Practice Address - Street 2:
Practice Address - City:PITTSGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08318
Practice Address - Country:US
Practice Address - Phone:856-358-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst