Provider Demographics
NPI:1629731252
Name:GRECO, KEITH ANTHONY (LMT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ANTHONY
Last Name:GRECO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 CLARKE ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3319
Mailing Address - Country:US
Mailing Address - Phone:516-424-4038
Mailing Address - Fax:
Practice Address - Street 1:11 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5705
Practice Address - Country:US
Practice Address - Phone:631-333-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist