Provider Demographics
NPI:1093727661
Name:GREGO, PATRICIA J (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:GREGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 679B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-0026
Mailing Address - Fax:585-242-9549
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0002
Practice Address - Country:US
Practice Address - Phone:585-275-0026
Practice Address - Fax:585-242-9549
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9301610363LA2200X, 363L00000X
NY301760363L00000X, 363LA2200X
NY224533163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03277823Medicaid
NYBB8764Medicare ID - Type Unspecified
NY03277823Medicaid
FLCZ812ZMedicare PIN