Provider Demographics
NPI:1558499137
Name:GREEN, JEFFREY HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HARRIS
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 COLD SOIL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-4202
Mailing Address - Country:US
Mailing Address - Phone:609-896-1122
Mailing Address - Fax:
Practice Address - Street 1:170 COLD SOIL ROAD
Practice Address - Street 2:CEDAR GLEN PROFESSIONAL ASSOCIATION
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-4202
Practice Address - Country:US
Practice Address - Phone:609-896-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA475492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA47549OtherNJ LICENSE NUMBER
NJE54987Medicare UPIN