Provider Demographics
NPI:1518229749
Name:FORTE, GREGORY (MSED)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:FORTE
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CANAAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2804
Mailing Address - Country:US
Mailing Address - Phone:917-612-8127
Mailing Address - Fax:
Practice Address - Street 1:1 CANAAN RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2804
Practice Address - Country:US
Practice Address - Phone:917-612-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist