Provider Demographics
NPI:1518035500
Name:GRECCO, DOMINIC M (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:M
Last Name:GRECCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 S BEDFORD RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3441
Mailing Address - Country:US
Mailing Address - Phone:914-241-4900
Mailing Address - Fax:914-241-4976
Practice Address - Street 1:59 KENSICO DRIVE
Practice Address - Street 2:
Practice Address - City:MT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-241-4900
Practice Address - Fax:914-241-4976
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1792631207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E44891Medicare UPIN
NY47F991Medicare PIN