1902179898 NPI number — 2D RECON BN

Table of content: JOSHUA L GREEN LAC, EAMP, MQP (NPI 1295018208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902179898 NPI number — 2D RECON BN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
2D RECON BN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902179898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2D MARINE DIVISION, 2D RECON BN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMP LEJEUNE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28542-0138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-440-7401
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2D MARINE DIVISION, 2D RECON BN
Provider Second Line Business Practice Location Address:
PSC BOX 20138
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28542-0138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-440-7401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KAMINSKY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BATTALION SURGEON
Authorized Official Telephone Number:
910-440-7712

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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