Provider Demographics
NPI:1437393725
Name:COLEMAN, GREGORY JOHN
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:JOHN
Other - Last Name:ZIENTARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:244 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3304
Mailing Address - Country:US
Mailing Address - Phone:610-372-8822
Mailing Address - Fax:610-372-6626
Practice Address - Street 1:244 N 5TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3304
Practice Address - Country:US
Practice Address - Phone:610-372-8822
Practice Address - Fax:610-372-6626
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009310L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist