Provider Demographics
NPI:1235492018
Name:CHRISTOPHER GRIECO, PSY.D., P.C.
Entity Type:Organization
Organization Name:CHRISTOPHER GRIECO, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GRIECO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-384-9032
Mailing Address - Street 1:212 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2362
Mailing Address - Country:US
Mailing Address - Phone:516-384-9032
Mailing Address - Fax:516-433-0471
Practice Address - Street 1:212 SOUTH ST
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2362
Practice Address - Country:US
Practice Address - Phone:516-384-9032
Practice Address - Fax:516-433-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015617-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400101325Medicare PIN