Provider Demographics
NPI:1851376271
Name:GREEN, JASON D (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:532 LAFAYETTE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-4411
Mailing Address - Country:US
Mailing Address - Phone:973-940-0423
Mailing Address - Fax:973-940-0399
Practice Address - Street 1:532 LAFAYETTE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-4411
Practice Address - Country:US
Practice Address - Phone:973-383-3730
Practice Address - Fax:973-383-2285
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2012-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY176080208C00000X
NJ25MA08183300208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110939Medicare PIN
71H272Medicare ID - Type Unspecified
F60940Medicare UPIN