Provider Demographics
NPI:1295989358
Name:REDMON, GREGG ALLEN (MED)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:ALLEN
Last Name:REDMON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:MR
Other - First Name:GREGG
Other - Middle Name:ALLEN
Other - Last Name:REDMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MED
Mailing Address - Street 1:138 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2119
Mailing Address - Country:US
Mailing Address - Phone:646-512-1620
Mailing Address - Fax:
Practice Address - Street 1:138 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2119
Practice Address - Country:US
Practice Address - Phone:646-512-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist