Provider Demographics
NPI:1669485173
Name:JOHN S GRECO JR MD PA
Entity Type:Organization
Organization Name:JOHN S GRECO JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:732-741-7997
Mailing Address - Street 1:PO BOX 7400
Mailing Address - Street 2:JOHN S GRECO JR MD PA
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-7400
Mailing Address - Country:US
Mailing Address - Phone:732-741-7997
Mailing Address - Fax:732-741-8746
Practice Address - Street 1:130 MAPLE AVE BLDG 4
Practice Address - Street 2:JOHN S GRECO JR MD PA
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1734
Practice Address - Country:US
Practice Address - Phone:732-741-7997
Practice Address - Fax:732-741-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05895200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5994209Medicaid
NJ5604760001Medicare NSC
NJ181694Medicare PIN
F40905Medicare UPIN