Provider Demographics
NPI:1427217330
Name:GREGORY, JESSICA MS (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MS
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3906
Mailing Address - Country:US
Mailing Address - Phone:631-689-7848
Mailing Address - Fax:
Practice Address - Street 1:9 CARLTON AVE
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3906
Practice Address - Country:US
Practice Address - Phone:631-689-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003613171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist