Jerry A. Green, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

023599 Issued in CT

Practice address

67 Aunt Hack Rd
Danbury, CT 06811-2720

Phone

(203) 798-6566

Fax

(203) 790-5883

NPI assigned

Jan 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1497734347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 AUNT HACK RD",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068112720",
            "telephone_number": "203-798-6566",
            "fax_number": "203-790-5883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 AUNT HACK RD",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068112720",
            "telephone_number": "203-798-6566",
            "fax_number": "203-790-5883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JERRY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-10",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CT",
            "license": "023599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001235993",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Danbury, CT
• Providers in Danbury, CT by specialty
• Specialist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; 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.