Provider Demographics
NPI:1992867246
Name:BARON, GREGG M (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:M
Last Name:BARON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3174 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2100
Mailing Address - Country:US
Mailing Address - Phone:631-737-3600
Mailing Address - Fax:631-737-3696
Practice Address - Street 1:3174 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2100
Practice Address - Country:US
Practice Address - Phone:631-737-3600
Practice Address - Fax:631-737-3696
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor