Provider Demographics
NPI:1629074638
Name:GRECO-TARTAGLIA, GINA (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GRECO-TARTAGLIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 VETERANS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4437
Mailing Address - Country:US
Mailing Address - Phone:914-245-4186
Mailing Address - Fax:914-962-9059
Practice Address - Street 1:225 VETERANS RD STE 102
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4437
Practice Address - Country:US
Practice Address - Phone:914-245-4186
Practice Address - Fax:914-962-9059
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G74248Medicare UPIN
NY9X2231Medicare ID - Type Unspecified