Provider Demographics
NPI:1942911714
Name:GRECO, TIMOTHY BRYAN
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRYAN
Last Name:GRECO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1793 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1032
Mailing Address - Country:US
Mailing Address - Phone:716-481-0857
Mailing Address - Fax:
Practice Address - Street 1:1408 SWEET HOME RD STE 1
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2783
Practice Address - Country:US
Practice Address - Phone:716-481-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404534363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health