Provider Demographics
NPI:1740603430
Name:GREENE, JOHN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:GREENE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07015-0031
Mailing Address - Country:US
Mailing Address - Phone:347-879-9494
Mailing Address - Fax:
Practice Address - Street 1:82 NEWARK POMPTON TPKE STE 1
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1427
Practice Address - Country:US
Practice Address - Phone:347-879-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MS00016000291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory