Provider Demographics
NPI:1639525884
Name:GREEN, JUSTIN M (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1150 YOUNGS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8096
Mailing Address - Country:US
Mailing Address - Phone:716-636-7990
Mailing Address - Fax:716-636-7993
Practice Address - Street 1:3950 E ROBINSON RD STE 207
Practice Address - Street 2:
Practice Address - City:W AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2044
Practice Address - Country:US
Practice Address - Phone:716-564-1111
Practice Address - Fax:716-564-1128
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2019-07-22
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Provider Licenses
StateLicense IDTaxonomies
NY300292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine