Provider Demographics
NPI:1932287042
Name:EMILI, GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:EMILI
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 1:4626 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1610
Mailing Address - Country:US
Mailing Address - Phone:718-547-4077
Mailing Address - Fax:718-547-4099
Practice Address - Street 1:4626 WHITE PLAINS RD
Practice Address - Street 2:1ST FLR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1610
Practice Address - Country:US
Practice Address - Phone:718-547-4077
Practice Address - Fax:718-547-4099
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211144207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02096748Medicaid
NY861411Medicare ID - Type Unspecified
NY02096748Medicaid