Provider Demographics
NPI:1114961703
Name:GREGORY, ANDREW PAUL THOMAS (DC, FNP-C, RNCST)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PAUL THOMAS
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DC, FNP-C, RNCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4845
Mailing Address - Country:US
Mailing Address - Phone:860-872-6229
Mailing Address - Fax:
Practice Address - Street 1:460 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4845
Practice Address - Country:US
Practice Address - Phone:860-872-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT246ZE0600X
CT001133111NN0400X
CT118083163W00000X
CT6561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111NN0400XChiropractic ProvidersChiropractorNeurology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU55233Medicare UPIN
CT350001162Medicare ID - Type Unspecified
CTC03101Medicare ID - Type UnspecifiedCLINIC GROUP NUMBER