Provider Demographics
NPI:1760573125
Name:GREEN, DONALD HENRY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:HENRY
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 CLIFTON AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3642
Mailing Address - Country:US
Mailing Address - Phone:973-773-9882
Mailing Address - Fax:973-773-9883
Practice Address - Street 1:1135 CLIFTON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3642
Practice Address - Country:US
Practice Address - Phone:973-773-9882
Practice Address - Fax:973-773-9883
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03186600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06699Medicare UPIN
NJ460555ZCSYMedicare PIN