Green Podiatry LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

25MD00214300 Issued in NJ

Legal business name

GREEN PODIATRY LLC

Practice address

111 Maple Grove Blvd
Lumberton, NJ 08048-4617

Phone

(609) 217-8905

NPI assigned

Apr 21, 2013

Last updated

Apr 21, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. William J Green, DPM

Title

Owner

Phone

(609) 217-8905

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366502400000",
    "number": "1053755082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MAPLE GROVE BLVD",
            "city": "LUMBERTON",
            "state": "NJ",
            "postal_code": "080484617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MAPLE GROVE BLVD",
            "city": "LUMBERTON",
            "state": "NJ",
            "postal_code": "080484617",
            "telephone_number": "609-217-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN PODIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-21",
        "last_updated": "2013-04-21",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-217-8905",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00214300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P3800567",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1094025",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1725652",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5486904",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jowana D Green
• Anne Greenwood
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• Caitlin Olivia Gross
• Guardian Health and Wellness LLC

• Podiatrist in Lumberton, NJ
• Providers in Lumberton, NJ by specialty
• Podiatrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.