Provider Demographics
NPI:1639241565
Name:HRITCKO, GREGORY ALAN (MS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:HRITCKO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 OLD STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904
Mailing Address - Country:US
Mailing Address - Phone:607-729-0044
Mailing Address - Fax:607-729-9994
Practice Address - Street 1:174 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1049
Practice Address - Country:US
Practice Address - Phone:607-729-0044
Practice Address - Fax:607-729-9994
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006182225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01774487Medicaid
NYR55982Medicare UPIN
NY5041880001Medicare NSC
NY01774487Medicaid