Provider Demographics
NPI:1508810813
Name:GRECO, RONALD D (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:GRECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10988 BENNETT-STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14062
Mailing Address - Country:US
Mailing Address - Phone:716-363-6050
Mailing Address - Fax:833-471-6206
Practice Address - Street 1:10988 BENNETT-STATE ROAD
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14062
Practice Address - Country:US
Practice Address - Phone:716-363-6050
Practice Address - Fax:833-471-6206
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163801207Q00000X
NY163801-1207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01059618Medicaid
NYDD1760Medicare PIN