Provider Demographics
NPI:1932397742
Name:GREENE, GLENN JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:JOEL
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 JACOBS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WEST TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-1704
Mailing Address - Country:US
Mailing Address - Phone:609-462-0788
Mailing Address - Fax:
Practice Address - Street 1:72 JACOBS CREEK RD
Practice Address - Street 2:
Practice Address - City:WEST TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628-1704
Practice Address - Country:US
Practice Address - Phone:609-462-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA066434002083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH14053Medicare UPIN