Provider Demographics
NPI:1053463315
Name:SANDRA J. GRECO, MD, FACOG, PA
Entity Type:Organization
Organization Name:SANDRA J. GRECO, MD, FACOG, PA
Other - Org Name:COASTAL PELVIC FLOOR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-571-0972
Mailing Address - Street 1:279 3RD AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6205
Mailing Address - Country:US
Mailing Address - Phone:732-571-0972
Mailing Address - Fax:732-571-0748
Practice Address - Street 1:279 3RD AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6205
Practice Address - Country:US
Practice Address - Phone:732-571-0972
Practice Address - Fax:732-571-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07003900207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty