Provider Demographics
NPI:1750480646
Name:GRECO, ANNAMARIE
Entity Type:Individual
Prefix:DR
First Name:ANNAMARIE
Middle Name:
Last Name:GRECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 5TH AVE
Mailing Address - Street 2:SUITE#3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0110
Mailing Address - Country:US
Mailing Address - Phone:212-987-0123
Mailing Address - Fax:212-987-0653
Practice Address - Street 1:1050 5TH AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0110
Practice Address - Country:US
Practice Address - Phone:212-987-0123
Practice Address - Fax:212-987-0653
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170340208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01517284Medicaid
NY48Z81Medicare ID - Type Unspecified
NYD92140Medicare UPIN