Provider Demographics
NPI:1790753523
Name:GREEN, DOUGLAS STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:STEWART
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1199 PLEASANT VALLEY WAY
Mailing Address - Street 2:KESSLER INSTITUTE FOR REHABILITATION
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052
Mailing Address - Country:US
Mailing Address - Phone:973-325-6210
Mailing Address - Fax:973-243-6861
Practice Address - Street 1:1199 PLEASANT VALLEY WAY
Practice Address - Street 2:KESSLER INSTITUTE FOR REHABILITATION
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-325-6210
Practice Address - Fax:973-243-6861
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA45011207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F02745OtherHEALTHNET
44611OtherAETNA
NJ1948504Medicaid
1551579OtherOXFORD INSURANCE
290008079OtherPALMETTO
D19058Medicare UPIN
290008079OtherPALMETTO