Provider Demographics
NPI:1477709020
Name:GREGORY F. DAVIES
Entity Type:Organization
Organization Name:GREGORY F. DAVIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-496-7676
Mailing Address - Street 1:175 JERICHO TPKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4532
Mailing Address - Country:US
Mailing Address - Phone:516-496-7676
Mailing Address - Fax:516-496-0422
Practice Address - Street 1:175 JERICHO TPKE
Practice Address - Street 2:SUITE 300
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4532
Practice Address - Country:US
Practice Address - Phone:516-496-7676
Practice Address - Fax:516-496-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003180261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4727750001Medicare NSC