Provider Demographics
NPI:1558303438
Name:GRECO, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
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 1:33 ANN DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5906
Mailing Address - Country:US
Mailing Address - Phone:516-238-6516
Mailing Address - Fax:952-942-3361
Practice Address - Street 1:33 ANN DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-5906
Practice Address - Country:US
Practice Address - Phone:516-238-6516
Practice Address - Fax:952-942-3361
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1662122085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0232CCOtherMEDICARE GHI
NY01768661Medicaid
D92000Medicare UPIN
NY0232CCOtherMEDICARE GHI