Provider Demographics
NPI:1730285651
Name:SCIMECA, GREGORY H (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:H
Last Name:SCIMECA
Suffix:
Gender:M
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 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1109
Mailing Address - Country:US
Mailing Address - Phone:609-877-2800
Mailing Address - Fax:609-877-1813
Practice Address - Street 1:225 SUNSET RD
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1109
Practice Address - Country:US
Practice Address - Phone:609-877-2800
Practice Address - Fax:609-877-1813
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04848700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5159202Medicaid
NJ5159202Medicaid
NJP00306615Medicare PIN
NJE88619Medicare UPIN