Individual
MRS. SANDRA ROSE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MEDICAL TRANSPORT
Contact information
Practice address
200 SPRING VALLEY AVE, HACKENSACK, NJ 07601-2944
(201) 656-2350
(201) 656-1719
Mailing address
200 SPRING VALLEY AVE, HACKENSACK, NJ 07601-2944
(201) 656-2350
(201) 656-1719
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
G73056897951662
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0450406503
—
NJ
Enumeration date
09/19/2019
Last updated
09/19/2019
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