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Provider Information for 1528695905

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

BRYAN M GREEN

Gender: MALE

Individual NPI: 1528695905

Calendar   Last Updated:  2020-03-25
  Certification Date:  2020-03-25

Details

Name Value
NPI 1528695905
Enumeration Date 2020-03-25
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 12 GARDEN ST
CHATHAM, NJ 07928-1437
United States

Phone: 973-738-6768 | Fax:
View Map External Link
Primary Practice Address 1 GUSTAVE L LEVY PL
NEW YORK, NY 10029-6504
United States

Phone: 973-738-6768 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 390200000X - Student in an Organized Health Care Education/Training Program