Individual
MS. KATIE E GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
457 JACK MARTIN BLVD., BRICK, NJ 08724
(732) 840-7500
(732) 840-2088
Mailing address
457 JACK MARTIN BLVD., BRICK, NJ 08724
(732) 840-7500
(732) 840-2088
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00367400
NJ
363AM0700X
Medical Physician Assistant
014932-1
NY
Other
Enumeration date
08/23/2011
Last updated
04/10/2018
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