Provider Demographics
NPI:1508373457
Name:GRESH, TANYA K (MS SPECIAL ED)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:K
Last Name:GRESH
Suffix:
Gender:F
Credentials:MS SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E 78TH ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1178
Mailing Address - Country:US
Mailing Address - Phone:347-372-4647
Mailing Address - Fax:
Practice Address - Street 1:501 E 78TH ST APT 4B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1178
Practice Address - Country:US
Practice Address - Phone:347-372-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY252Y00000XMedicaid