Green, Justin Jacob

Green, Justin Jacob is an individual health care provider with primary practice located at 10000 Sagemore Dr Ste 10101 , Marlton NJ 08053-3944. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Green, Justin Jacob can be contacted via phone (856) 596-0111.

Contact Information

Primary practice address
10000 Sagemore Dr Ste 10101 Marlton NJ 08053-3944
Phone: (856) 596-0111
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 25MA07058200 New Jersey
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 25MA07058200 New Jersey

Profile Details

NPI number 1104894872
LBN Legal business name Green, Justin Jacob
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 9th, 2006
Last updated Jun 17th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104894872 NPPES
New Jersey MEDICAID 8908702

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