Provider Demographics
NPI:1689728107
Name:WINTHROP COMMUNITY MEDICAL AFFILIATES, P.C.
Entity Type:Organization
Organization Name:WINTHROP COMMUNITY MEDICAL AFFILIATES, P.C.
Other - Org Name:WINTHROP CHILD NEUROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-663-8209
Mailing Address - Street 1:173 MINEOLA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2528
Mailing Address - Country:US
Mailing Address - Phone:516-663-9494
Mailing Address - Fax:516-663-2835
Practice Address - Street 1:173 MINEOLA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2528
Practice Address - Country:US
Practice Address - Phone:516-663-9494
Practice Address - Fax:516-663-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03079632Medicaid
NY03079632Medicaid