Provider Demographics
NPI:1245503523
Name:GREEN, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:GREEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:375 MOUNT PLEASANT AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2750
Mailing Address - Country:US
Mailing Address - Phone:973-323-1320
Mailing Address - Fax:973-323-1347
Practice Address - Street 1:777 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-2325
Practice Address - Country:US
Practice Address - Phone:973-429-0462
Practice Address - Fax:973-429-8765
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2024-06-21
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Provider Licenses
StateLicense IDTaxonomies
NY262278208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ290179ZASEMedicare PIN